Student name

In the above box, please list the name of the student who requested that you complete a reference on their behalf; this is part of their application for a scholarship from available funds through Disciples Home Missions, Christian Church (Disciples of Christ). They cannot be considered for a scholarship unless DHM receives all of their required references.

Please complete this form by marking the checklist items below to identify potential for ministry, general character, academic ability, and relational skills. We realize that there are some sections you may not be able to complete.

Return this form by April 15.

Date

/ /  (mm/dd/yy)

Describe the student's potential for ministry.

Relationship to applicant (please check the category you've been requested by the applicant to fulfill):

Pastor of your congregation
Regional staff/recognized executive minister of racial/ethnic ministries
Dean/professor/counselor

Your name

Address

City

State

  Postal code

E-mail

 Telephone

Once you complete this form, you must click the "Submit reference" button to send the reference to DHM.