STINT Reference Form - Todd Becker Foundation

Phone(Required)

Email(Required)

Age(Required)

How long have you known the STINT Applicant?(Required)

What is your relationship to the STINT Applicant?(Required)

How well would you say you know the STINT Applicant?(Required)

Please rate the STINT Applicant on the following

On a scale 1-5: Poor - Below Average – Average – Above Average – Excellent

Ability to receive correction(Required)

Self Confidence(Required)

Ability to make decisions(Required)

Social Ability(Required)

Longing to grow/get better(Required)

Mental Ability(Required)

Work Ethic(Required)

Follow-through(Required)

Teamwork(Required)

Coachability/Teachability(Required)

Christian Character(Required)

Attitude(Required)

Punctuality(Required)

Personal hygiene(Required)

How does the applicant usually react when faced with correction or redirection to their character or their personal growth?(Required)

Does the applicant struggle with (or has struggled with) drugs, alcohol, smoking, pornography, mental illness?(Required)

If yes, please explain.

What are some of the applicant’s strengths?(Required)

please include special abilities/talents

What are some of the applicant’s weaknesses?(Required)

Do you recommend the applicant for the Todd Becker Foundation’s STINT Internship program?(Required)

Please explain your answer

I consent to submitting my personal information to the Todd Becker Foundation STINT program for the purposes of processing this Character Reference Form.(Required)

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