International Affairs

3000 Mountain Creek Parkway ♦ Dallas, Texas 75211

Office: 214-333-5427 ext. 6859 ♦ Fax: 214-333-5878 ♦ Email: todd@dbu.edu

November 11, 2018

Dear Applicant,

Thank you for your interest in serving in this year’s English Camp Program. I am excited about the camp that

will take place in Beijing, China in July 9-August 5 2019. The trip will be approximately 25 days. I look

forward to helping you prepare for this wonderful opportunity to share Jesus through the tool of camp

counseling and teaching English as a second language!

Enclosed in this packet is an application form you will need to read carefully, complete, and return as soon as

possible. In addition, five reference forms are included for you to distribute as soon as possible. Please know

that it is your responsibility to ensure your references have been submitted. The deadline to apply is

Thursday, February 28, 2019. Spaces will be limited this year so apply quickly. This application packet

will also be available online at www.dbu.edu/teachenglish .

After you have submitted your application and all of your references have been received, your application

will be reviewed and then you will be notified or contacted to schedule an interview. Upon completion of the

interview, you will be notified regarding acceptance or denial into the program. Please allow at least one

week for evaluation from time of interview.

Please feel free to contact me during regular business hours if you have any questions. Thank you again for

your interest! I pray God continues to bless you in all your studies and endeavors this semester.

Sincerely,

Todd Oriarte

Coordinator of the Intensive English Program

Enclosures:

Application Form

Reference Forms

2019 ENGLISH CAMP

PROGRAM APPLICATION

Dallas Baptist University is offering a practicum teaching English in Beijing, China for 3-4 weeks in July. Actual trip dates will be released later. All participants will receive training and orientation at DBU in June as part of the requirements for the practicum course. All participants must obtain a valid U.S. passport and have at least six months of validity from the time of return to the U.S. DBU will process the visa application. Participants will also be required to purchase medical insurance for overseas travel and acquire all needed immunizations prior to departure.

The deadline to apply is February 28, 2019. Completed applications with all required documents are to be turned in to Todd Oriarte in the Moon International Center. Participants are responsible for references being turned in on time. In addition, immediately after acceptance, a $250 deposit will be required. This deposit is refundable upon successful completion of the program. An interview will be scheduled upon application completion.

A. PERSONAL INFORMATION (PLEASE PRINT) Name: Last First DBU Student ID#

Middle (Not initial):

Sex Age Date of Birth / / mm/ dd /yy

Marital Status: Single (never married) Engaged: Wedding date ____________ Married Separated or divorced

Current Mailing Address:

Street: City: State: Zip Code: Preferred Email Address: DBU Email Address: Phone # ( ) Cell Phone # ( )

Permanent / Parents’ Mailing Address Street: City: State: Zip Code: Parents’ email address: Parents’ Phone #: ( )

Country of Citizenship: If not a U.S. citizen, then are you a permanent resident? YES NO If not born in the U.S., what year did you move to the U.S.?

Passport Number: Country: Expiration Date:

Are you a native English speaker? Y N

Are you a full-time DBU student/employee? Y N How did you hear about the program?

B. Emergency Contact Name: Last First

Relationship: Please check one

Parent/Guardian Sibling Friend

Other (Please list) _________________

Address: (If different than above)

Street: City: State: Zip Code:

Preferred Email Address:

Phone: (If different than above) Home (______)_____________________

Cell (______)_____________________

D.O.B.:

PHOTO

REQUIRED

PHOTO

REQUIRED

DBU ID#:

C. Church Membership Local Church Membership City State

Are you a member and for how long? No Yes Years:

Do you attend church on a weekly basis? No Yes

Pastor’s Name: Level of Relationship: Casual Well Very Well

Local Church Phone #: ( )

Other minister that knows you well:

Denominational Affiliation:

If you are not a member of the church you attend while in college, where is your membership?

Home Church (if different from above) City State Pastor’s Name: Church Phone #: ( )

Activities in home and/or local church

D. EDUCATION Check your classification at the end of the Spring 2019 term: Freshman Sophomore Junior Senior Graduate

How many semesters have you been at DBU?

Total hours completed by May 2019 _______ hrs.

GPA: Major: Minor:

Vocational choice

Other Colleges, Universities, or Seminaries Attended (Attach additional sheet if needed) Name:

No. Hours/Degree Major:

E. DBU EXPERIENCE Projected Date of Graduation: Desired Degree:

Payment History

Current Balance:

Payments on time: Y N

In good standing: Y N

Since attending DBU you have lived: On campus: Y N Length of Time: _ RA: _____________________ Off campus: Y N Length of Time: _________ Roommate: _______________________

If there have been any conflicts with Student Affairs or Residence Life, please explain.

List any academic honors/awards.

List any organizational involvement and positions held.

List any BSM involvement or other DBU ministry involvement.

Briefly summarize your educational, social, and spiritual experiences at DBU.

Briefly describe your future goals in terms of occupation. Where do you see yourself in five years?

DBU ID#:

F. HEALTH INFORMATION My health is:

Excellent Good Fair Poor

Are you currently on any medication?

YES NO If so, give name and reason. Include OTC medications. ___________________________ ___________________________

Are you under the care of a physician due to physical or mental conditions which may limit your ability to serve in some assignments?

YES NO If yes, please explain: ______________________________________ ________________________________________________________

Have you ever been under psychiatric care? Yes No If yes, please explain on a separate sheet of paper.

Do you drink alcohol, smoke, or use any kind of tobacco products ? Yes No If so, please explain on a separate sheet of paper.

Insurance Name: Policy Number: Group ID: Expiration Date: Policy Holder:

G. TEAMWORK Would other adults say you work well with others? Why or why not?

How often do you find yourself in conflict with others? Explain.

Are you willing to follow policies and leadership decisions even though you might not agree with a decision?

Yes No If no, then please explain:

H. REFERENCES Please list the name, email address, and phone number of references below. (Please do not use family members)

Reference Name E-mail Phone

1. Pastor or Church Staff Member

H: W: C:

2. DBU Faculty or Full-Time Staff

H: W: C:

3. Work Supervisor H: W: C:

4. RD/RA (if never in a dorm, substitute another DBU faculty or staff)

H: W: C:

5. Roommate (if never with a roommate, substitute a co-worker)

H: W: C:

I. TEACHING, EVANGELISM, AND CULTURAL EXPERIENCE 1. What are some offices/positions you have held, projects you have completed, or experiences you have had that have helped you to

develop a sense of responsibility and leadership? Please explain.

2. Briefly describe any cross-cultural experiences you have had.

DBU ID#:

3. List all experiences and training you have had related to evangelism.

4. List all experiences and training you have had related to teaching.

J. TALENTS, ABILITIES, AND MINISTRY EXPERIENCE Have you served in student missions before? Y N Type of ministry:____________________________________ Place:______________________________ Length of time:_______

Indicate experience in the following: Novice (Nov.), Intermediate (Int.), Extensive (Ext.) Nov. Int. Ext. Nov. Int. Ext. Nov. Int. Ext.

VBS/Camp Evangelism Song Leading

Recreation Drama/Puppets Bible Teaching

Share Testimony Teaching ESL Youth Ministry

Please describe other experiences you feel may be helpful:

ANY INSTRUMENTS PLAYED Indicate skill level: Beginner, Intermediate, Advanced

Guitar

Piano

Other: Please list ________________

LANGUAGES / PROFICIENCY LEVEL (other than English) Read Write Speak Some Fluent

1.

2.

K. WORK EXPERIENCE Please provide a list of all your employers for the past two years (Beginning with the most recent job).

Employer: Dates employed: Supervisor: Phone:

Job title/responsibilities: Reason for leaving:

Employer: Dates employed: Supervisor: Phone:

Job title/responsibilities: Reason for leaving:

Employer: Dates employed: Supervisor: Phone:

Job title/responsibilities: Reason for leaving:

Employer: Dates employed: Supervisor: Phone:

Job title/responsibilities: Reason for leaving:

DBU ID#:

L. EXPRESSION OF CHRISTIAN FAITH Please limit your answers to the space allowed.

1. Briefly describe your initial encounter with Jesus Christ. How has this experience and a continuing relationship with Christ affected your life?

.

2. As a college student, how have you shared your faith with others? If applicable, describe a recent experience of sharing your faith with someone who was not a Christian.

3. State your reason(s) for wanting to minister as a teacher in the DBU English Camp Program.

DBU ID#:

M. POLICY AGREEMENT FOR PARTICIPANTS OF DBU SUMMER ENGLISH PROGRAM

Alcohol/Drug/Tobacco Use — Participant agrees to abstain from any use, promotion, or transport of alcoholic beverages, drugs, and tobacco for the duration of the trip. Failure to adhere to this policy

will result in immediate dismissal and return to the U.S. in which participant will be financially responsible for airfare/travel expenses and will be required to meet with the Dean of Student Affairs upon return.

E-mail/Communication — Participant agrees to follow guidelines specific to the site. Wording must be

guarded to avoid harm to other participants and site hosts. Attire — Participant is a representative of DBU and a model for Christianity. Therefore, the participant's

attire must be business casual during teaching hours. Financial Responsibility — Participant will provide a $250 deposit upon acceptance. Participant is

responsible for paying for passport, visa, travel insurance, any needed immunizations, class tuition, and personal expenses. Flight, room and board, weekend activities, and most meals are free for the participant. If a participant cancels, then he/she is responsible for any and all financial expenses incurred except in the case of a major medical or family emergency. Participant is responsible for expenses due to the dismissal and removal from the program.

Training Responsibility — Participant will register for the three-hour credit upper-level course, Practicum

in Cross Cultural Perspectives (Long Summer term) and attend training prior to trip departure. Schedule and class will be announced at a later date.

Exclusive Relationship — Dating, getting engaged, and the forming of exclusive relationships are not

allowed while on the trip. Trips Home — Trips home are not allowed except for emergencies within the immediate family. The

participant must inform the team director and the DBU camp coordinator if an emergency arises requiring a trip home. Trips will be made at the participant’s expense.

Family Visits — If a family member plans to visit the participant while overseas, the participant must obtain

approval from the team director prior to the visit. Also, it is vital that any visits from family do not interfere with teaching duties or responsibilities.

Questionable Conduct — The participant must seek to avoid all inappropriate behavior, including anything

that would hinder his/her ministry or DBU’s ministry during the term of service. BY SIGNING BELOW, I CONFIRM:

I have read and agree to comply with all the above policies. I understand that if I choose not to adhere to any of these policies it could lead to my dismissal from the program. I understand that if I am dismissed from the program while overseas, I am responsible for all expenses incurred for my early return to the USA.

I have completed all of the application questions to the best of my ability, and I guarantee the information is true and accurate.

Printed Name: Date: Signature: Witness:

2019 English Camp Program Reference DBU Faculty or Full-Time Staff

Confidential Reference for DBU ID #:

(Applicant’s name)

How long have you known your reference? years months

In what capacity have you known your reference?

Applicant’s Statement: I am aware that under the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.

Sec. 1232 {a} {1} {C}), I am not required to, but I may voluntarily, waive my right to access confidential

letters and statements of recommendation submitted to Dallas Baptist University (DBU) in support of my

application for the English Camp Program (ECP) by DBU. I further understand that an unsuccessful

applicant, regardless of whether such applicant has signed a waiver, has no right to inspect any of that

applicant’s application materials. The giving of a waiver shall not be regarded as a condition for

acceptance into the ECP by DBU.

I hereby: do / do not waive my rights of access to any and all letters or statements of recommendation

which may be submitted by

(Applicant must specify the name of the person submitting recommendation before sending this form to

that person.)

Applicant’s Signature: Date:

Dear Reference,

Thank you for taking the time to fill out this reference sheet for the student listed above. Please answer

these questions as objectively as possible in order for the selection committee to know adequately if the

student meets the criteria and qualities needed to serve in this capacity. Your comments will be held in

confidence.

Please mail, fax, or email this reference before February 28, 2019 to Todd Oriarte, Moon

International Center, Dallas Baptist University, 3000 Mountain Creek Pkwy., Dallas, TX 75211.

Fax: 214-333-5878. Email: todd@dbu.edu.

Reference Name Phone Number H W C

Email Address Secondary Phone Number H W C

_________________________ Employer Position

_________________________ Church Name Pastor

Church Mailing Address City State Zip

How well do you feel you know the applicant? Casual 1 2 3 4 5 6 7 8 9 10 Very Well

What level of communication have you had with the applicant in the past six months?

None Casual Personal Very Personal

Confidential Reference for _________________ (Applicant’s name) (DBU ID#)

General Characteristics: Check any traits listed that characterize the applicant.

Fault-finder

Teachable

Impulsive

Friendly

Mature

Flexible

Argumentative

Extrovert

Introvert

Relates well to other

cultures/races

Often needs emotional

support

Responsible

Self-starter

Moody

Low self-esteem

Sensitive and caring

Pleasant to be with

Shy

Follower

Pessimistic

Quick-tempered

Lazy

Constantly complaining

Easily discouraged

Uses inappropriate humor

Has respect of others

Shares faith naturally

Leader

Compassionate

Reserved

Authentic

Please evaluate the applicant in the following areas by checking the appropriate boxes:

We would welcome any additional insight you might have concerning this applicant. Please use an additional sheet.

If you would prefer to share some information by phone, please provide a number and time that you may be reached

during the day. Phone: _____________________ Time: ____________

Signature Date

In class:

Diligent student

Good student

Mediocre student

Irresponsible student

No information

Personal judgment:

Consistent good judgment

Previous judgment poor, present judgment good

Poor or lacking judgment

No information

Maturity:

Emotionally mature

Growing

Needs direction and growth

Very immature

No information

Communication:

Clear, confident in his or her communication

Average in communication ability

Unable to communicate clearly

No information

On a team of 2 to 4 students, this person would

likely be:

The leader

A supportive team member

A self-starting team member

A low initiative follower

Uncooperative

No information

Working in group settings:

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has constant problems relating and working with

fellow peers

No information

Making friends:

Drawn to people

Good at making friends

Slow or reserved at making friends

Struggles to make friends, awkward

No information

Please indicate the level of your recommendation:

Strongly recommend

Recommend

Recommend with some reservation

Do not recommend

Please share strengths of the applicant:

__________________________________

__________________________________

__________________________________

Please share weaknesses of the applicant:

_____________________________________

_____________________________________

_____________________________________

2019 English Camp Program Reference by Pastor or Church Staff Member

Confidential Reference for DBU ID #:

(Applicant’s name)

How long have you known your reference? years months

In what capacity have you known your reference?

Applicant’s Statement: I am aware that under the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.

Sec. 1232 {a} {1} {C}), I am not required to, but I may voluntarily, waive my right to access confidential

letters and statements of recommendation submitted to Dallas Baptist University (DBU) in support of my

application for the English Camp Program (ECP) by DBU. I further understand that an unsuccessful

applicant, regardless of whether such applicant has signed a waiver, has no right to inspect any of that

applicant’s application materials. The giving of a waiver shall not be regarded as a condition for

acceptance into the ECP by DBU.

I hereby: do / do not waive my rights of access to any and all letters or statements of recommendation

which may be submitted by

(Applicant must specify the name of the person submitting recommendation before sending this form to

that person.)

Applicant’s Signature: Date:

Dear Reference,

Thank you for taking the time to fill out this reference sheet for the student listed above. Please answer

these questions as objectively as possible in order for the selection committee to know adequately if the

student meets the criteria and qualities needed to serve in this capacity. Your comments will be held in

confidence.

Please mail, fax, or email this reference before February 28, 2019 to Todd Oriarte, Moon

International Center, Dallas Baptist University, 3000 Mountain Creek Pkwy., Dallas, TX 75211.

Fax: 214-333-5878. Email: todd@dbu.edu.

Reference Name Phone Number H W C

Email Address Secondary Phone Number H W C

_________________________ Employer Position

_________________________ Church Name Pastor

Church Mailing Address City State Zip

How well do you feel you know the applicant? Casual 1 2 3 4 5 6 7 8 9 10 Very Well

What level of communication have you had with the applicant in the past six months?

None Casual Personal Very Personal

Confidential Reference for _________________ (Applicant’s name) (DBU ID#)

General Characteristics: Check any traits listed that characterize the applicant.

Fault-finder

Teachable

Impulsive

Friendly

Mature

Flexible

Argumentative

Extrovert

Introvert

Relates well to other

cultures/races

Often needs emotional

support

Responsible

Self-starter

Moody

Low self-esteem

Sensitive and caring

Pleasant to be with

Shy

Follower

Pessimistic

Quick-tempered

Lazy

Constantly complaining

Easily discouraged

Uses inappropriate humor

Has respect of others

Shares faith naturally

Leader

Compassionate

Reserved

Authentic

Please evaluate the applicant in the following areas by checking the appropriate boxes:

We would welcome any additional insight you might have concerning this applicant. Please use an additional sheet.

If you would prefer to share some information by phone, please provide a number and time that you may be reached

during the day. Phone: _____________________ Time: ____________

Signature Date

In class:

Diligent student

Good student

Mediocre student

Irresponsible student

No information

Personal judgment:

Consistent good judgment

Previous judgment poor, present judgment good

Poor or lacking judgment

No information

Maturity:

Emotionally mature

Growing

Needs direction and growth

Very immature

No information

Communication:

Clear, confident in his or her communication

Average in communication ability

Unable to communicate clearly

No information

On a team of 2 to 4 students, this person would

likely be:

The leader

A supportive team member

A self-starting team member

A low initiative follower

Uncooperative

No information

Working in group settings:

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has constant problems relating and working with

fellow peers

No information

Making friends:

Drawn to people

Good at making friends

Slow or reserved at making friends

Struggles to make friends, awkward

No information

Please indicate the level of your recommendation:

Strongly recommend

Recommend

Recommend with some reservation

Do not recommend

Please share strengths of the applicant:

__________________________________

__________________________________

__________________________________

Please share weaknesses of the applicant:

_____________________________________

_____________________________________

_____________________________________

2019 English Camp Program

Reference by Work Supervisor

Confidential Reference for DBU ID #:

(Applicant’s name)

How long have you known your reference? years months

In what capacity have you known your reference?

Applicant’s Statement: I am aware that under the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.

Sec. 1232 {a} {1} {C}), I am not required to, but I may voluntarily, waive my right to access confidential

letters and statements of recommendation submitted to Dallas Baptist University (DBU) in support of my

application for the English Camp Program (ECP) by DBU. I further understand that an unsuccessful

applicant, regardless of whether such applicant has signed a waiver, has no right to inspect any of that

applicant’s application materials. The giving of a waiver shall not be regarded as a condition for

acceptance into the ECP by DBU.

I hereby: do / do not waive my rights of access to any and all letters or statements of recommendation

which may be submitted by

(Applicant must specify the name of the person submitting recommendation before sending this form to

that person.)

Applicant’s Signature: Date:

Dear Reference,

Thank you for taking the time to fill out this reference sheet for the student listed above. Please answer

these questions as objectively as possible in order for the selection committee to know adequately if the

student meets the criteria and qualities needed to serve in this capacity. Your comments will be held in

confidence.

Please mail, fax, or email this reference before February 28, 2019 to Todd Oriarte, Moon

International Center, Dallas Baptist University, 3000 Mountain Creek Pkwy., Dallas, TX 75211.

Fax: 214-333-5878. Email: todd@dbu.edu.

Reference Name Phone Number H W C

Email Address Secondary Phone Number H W C

_________________________ Employer Position

_________________________ Church Name Pastor

Church Mailing Address City State Zip

How well do you feel you know the applicant? Casual 1 2 3 4 5 6 7 8 9 10 Very Well

What level of communication have you had with the applicant in the past six months?

None Casual Personal Very Personal

Confidential Reference for _________________ (Applicant’s name) (DBU ID#)

General Characteristics: Check any traits listed that characterize the applicant.

Fault-finder

Teachable

Impulsive

Friendly

Mature

Flexible

Argumentative

Extrovert

Introvert

Relates well to other

cultures/races

Often needs emotional

support

Responsible

Self-starter

Moody

Low self-esteem

Sensitive and caring

Pleasant to be with

Shy

Follower

Pessimistic

Quick-tempered

Lazy

Constantly complaining

Easily discouraged

Uses inappropriate humor

Has respect of others

Shares faith naturally

Leader

Compassionate

Reserved

Authentic

Please evaluate the applicant in the following areas by checking the appropriate boxes:

We would welcome any additional insight you might have concerning this applicant. Please use an additional sheet.

If you would prefer to share some information by phone, please provide a number and time that you may be reached

during the day. Phone: _____________________ Time: ____________

Signature Date

In class:

Diligent student

Good student

Mediocre student

Irresponsible student

No information

Personal judgment:

Consistent good judgment

Previous judgment poor, present judgment good

Poor or lacking judgment

No information

Maturity:

Emotionally mature

Growing

Needs direction and growth

Very immature

No information

Communication:

Clear, confident in his or her communication

Average in communication ability

Unable to communicate clearly

No information

On a team of 2 to 4 students, this person would

likely be:

The leader

A supportive team member

A self-starting team member

A low initiative follower

Uncooperative

No information

Working in group settings:

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has constant problems relating and working with

fellow peers

No information

Making friends:

Drawn to people

Good at making friends

Slow or reserved at making friends

Struggles to make friends, awkward

No information

Please indicate the level of your recommendation:

Strongly recommend

Recommend

Recommend with some reservation

Do not recommend

Please share strengths of the applicant:

__________________________________

__________________________________

__________________________________

Please share weaknesses of the applicant:

_____________________________________

_____________________________________

_____________________________________

2019 English Camp Program

Reference by RA or RD

Confidential Reference for DBU ID #:

(Applicant’s name)

How long have you known your reference? years months

In what capacity have you known your reference?

Applicant’s Statement: I am aware that under the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.

Sec. 1232 {a} {1} {C}), I am not required to, but I may voluntarily, waive my right to access confidential

letters and statements of recommendation submitted to Dallas Baptist University (DBU) in support of my

application for the English Camp Program (ECP) by DBU. I further understand that an unsuccessful

applicant, regardless of whether such applicant has signed a waiver, has no right to inspect any of that

applicant’s application materials. The giving of a waiver shall not be regarded as a condition for

acceptance into the ECP by DBU.

I hereby: do / do not waive my rights of access to any and all letters or statements of recommendation

which may be submitted by

(Applicant must specify the name of the person submitting recommendation before sending this form to

that person.)

Applicant’s Signature: Date:

Dear Reference,

Thank you for taking the time to fill out this reference sheet for the student listed above. Please answer

these questions as objectively as possible in order for the selection committee to know adequately if the

student meets the criteria and qualities needed to serve in this capacity. Your comments will be held in

confidence.

Please mail, fax, or email this reference before February 28, 2019 to Todd Oriarte, Moon

International Center, Dallas Baptist University, 3000 Mountain Creek Pkwy., Dallas, TX 75211.

Fax: 214-333-5878. Email: todd@dbu.edu.

Reference Name Phone Number H W C

Email Address Secondary Phone Number H W C

_________________________ Employer Position

_________________________ Church Name Pastor

Church Mailing Address City State Zip

How well do you feel you know the applicant? Casual 1 2 3 4 5 6 7 8 9 10 Very Well

What level of communication have you had with the applicant in the past six months?

None Casual Personal Very Personal

Confidential Reference for _________________ (Applicant’s name) (DBU ID#)

General Characteristics: Check any traits listed that characterize the applicant.

Fault-finder

Teachable

Impulsive

Friendly

Mature

Flexible

Argumentative

Extrovert

Introvert

Relates well to other

cultures/races

Often needs emotional

support

Responsible

Self-starter

Moody

Low self-esteem

Sensitive and caring

Pleasant to be with

Shy

Follower

Pessimistic

Quick-tempered

Lazy

Constantly complaining

Easily discouraged

Uses inappropriate humor

Has respect of others

Shares faith naturally

Leader

Compassionate

Reserved

Authentic

Please evaluate the applicant in the following areas by checking the appropriate boxes:

We would welcome any additional insight you might have concerning this applicant. Please use an additional sheet.

If you would prefer to share some information by phone, please provide a number and time that you may be reached

during the day. Phone: _____________________ Time: ____________

Signature Date

In class:

Diligent student

Good student

Mediocre student

Irresponsible student

No information

Personal judgment:

Consistent good judgment

Previous judgment poor, present judgment good

Poor or lacking judgment

No information

Maturity:

Emotionally mature

Growing

Needs direction and growth

Very immature

No information

Communication:

Clear, confident in his or her communication

Average in communication ability

Unable to communicate clearly

No information

On a team of 2 to 4 students, this person would

likely be:

The leader

A supportive team member

A self-starting team member

A low initiative follower

Uncooperative

No information

Working in group settings:

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has constant problems relating and working with

fellow peers

No information

Making friends:

Drawn to people

Good at making friends

Slow or reserved at making friends

Struggles to make friends, awkward

No information

Please indicate the level of your recommendation:

Strongly recommend

Recommend

Recommend with some reservation

Do not recommend

Please share strengths of the applicant:

__________________________________

__________________________________

__________________________________

Please share weaknesses of the applicant:

_____________________________________

_____________________________________

_____________________________________

2019 English Camp Program

Reference by Roommate/Co-Worker

Confidential Reference for DBU ID #:

(Applicant’s name)

How long have you known your reference? years months

In what capacity have you known your reference?

Applicant’s Statement: I am aware that under the Family Educational Rights and Privacy Act of 1974 (20 U.S.C.

Sec. 1232 {a} {1} {C}), I am not required to, but I may voluntarily, waive my right to access confidential

letters and statements of recommendation submitted to Dallas Baptist University (DBU) in support of my

application for the English Camp Program (ECP) by DBU. I further understand that an unsuccessful

applicant, regardless of whether such applicant has signed a waiver, has no right to inspect any of that

applicant’s application materials. The giving of a waiver shall not be regarded as a condition for

acceptance into the ECP by DBU.

I hereby: do / do not waive my rights of access to any and all letters or statements of recommendation

which may be submitted by

(Applicant must specify the name of the person submitting recommendation before sending this form to

that person.)

Applicant’s Signature: Date:

Dear Reference,

Thank you for taking the time to fill out this reference sheet for the student listed above. Please answer

these questions as objectively as possible in order for the selection committee to know adequately if the

student meets the criteria and qualities needed to serve in this capacity. Your comments will be held in

confidence.

Please mail, fax, or email this reference before February 28, 2019 to Todd Oriarte, Moon

International Center, Dallas Baptist University, 3000 Mountain Creek Pkwy., Dallas, TX 75211.

Fax: 214-333-5878. Email: todd@dbu.edu.

Reference Name Phone Number H W C

Email Address Secondary Phone Number H W C

_________________________ Employer Position

_________________________ Church Name Pastor

Church Mailing Address City State Zip

How well do you feel you know the applicant? Casual 1 2 3 4 5 6 7 8 9 10 Very Well

What level of communication have you had with the applicant in the past six months?

None Casual Personal Very Personal

Confidential Reference for _________________ (Applicant’s name) (DBU ID#)

General Characteristics: Check any traits listed that characterize the applicant.

Fault-finder

Teachable

Impulsive

Friendly

Mature

Flexible

Argumentative

Extrovert

Introvert

Relates well to other

cultures/races

Often needs emotional

support

Responsible

Self-starter

Moody

Low self-esteem

Sensitive and caring

Pleasant to be with

Shy

Follower

Pessimistic

Quick-tempered

Lazy

Constantly complaining

Easily discouraged

Uses inappropriate humor

Has respect of others

Shares faith naturally

Leader

Compassionate

Reserved

Authentic

Please evaluate the applicant in the following areas by checking the appropriate boxes:

We would welcome any additional insight you might have concerning this applicant. Please use an additional sheet.

If you would prefer to share some information by phone, please provide a number and time that you may be reached

during the day. Phone: _____________________ Time: ____________

Signature Date

In class:

Diligent student

Good student

Mediocre student

Irresponsible student

No information

Personal judgment:

Consistent good judgment

Previous judgment poor, present judgment good

Poor or lacking judgment

No information

Maturity:

Emotionally mature

Growing

Needs direction and growth

Very immature

No information

Communication:

Clear, confident in his or her communication

Average in communication ability

Unable to communicate clearly

No information

On a team of 2 to 4 students, this person would

likely be:

The leader

A supportive team member

A self-starting team member

A low initiative follower

Uncooperative

No information

Working in group settings:

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has constant problems relating and working with

fellow peers

No information

Making friends:

Drawn to people

Good at making friends

Slow or reserved at making friends

Struggles to make friends, awkward

No information

Please indicate the level of your recommendation:

Strongly recommend

Recommend

Recommend with some reservation

Do not recommend

Please share strengths of the applicant:

__________________________________

__________________________________

__________________________________

Please share weaknesses of the applicant:

_____________________________________

_____________________________________

_____________________________________