The Urban Servant Corps

The Urban Servant Corps




This reference is to be complete by an individual who knows you well and can attest to your character and values to complete the Mission Reference. You may consider asking a spiritual mentor or companion, a trusted leader or individual. The reference may not be a relative, spouse, partner, or significant other.

Thank you for providing reference information as part of the application process to Border Servant Corps. Your open and honest responses will assist our efforts to be more sensitive to the applicant’s abilities and needs, service placement, and compatibility in community living. This information is confidential.


Name of Applicant: ______


How long and under what circumstances have you known this applicant?

Describe the applicant’s strengths.

In what areas does the applicant have room for growth?

How does the applicant interact with others from a different background?

How does the applicant respond to directives from peers or supervisors? How does the applicant respond when s/he disagrees?

For what type of work is the applicant best suited – direct social services, community organizing, indirect social services, public policy/advocacy? Why?

BSC’s four tenets are community, simplicity, social justice, and spirituality. Please speak to any experience you have had with the applicant that highlight their commitment to any/all of these values.

Please indicate which of the statements in each pair below best describes the applicant. If you have not observed the applicant in this situation, please leave that pair blank.

_____ Excels with group work

_____ Excels with independent work

_____ Enjoys a changing pace

_____ Enjoys a steady pace

_____ Excels with close supervision

_____ Excels with less supervision

_____ Likes to initiate projects

_____ Likes to carry out projects

_____ Likes to have a cyclical routine of


_____ Likes assignments to vary each day

_____ Seeks interaction with the public

_____ Prefers limited contact with the public

_____ Processes thoughts, preferences,

and ideas internally

_____ Processes thoughts, preferences,

and ideas externally


Check the box that you feel best describes how the applicant typically behaves on most days, on most projects, and with most people. / Almost Always / Usually / Occasionally / Rarely / Almost Never / Unable to Judge / Comments
Interacts well with others
Demonstrates leadership
Integrates beliefs and values into life experiences
Openly expresses feelings
Discusses social and/or ecological justice issues
Is involved in social and/or ecological concerns/causes
Demonstrates respect for those with other beliefs and values

List three adjectives that best describe the applicant:

1: ______2: ______3: ______

Please comment on any other aspects of this applicant that might be relevant.

At what level would you recommend this applicant for acceptance into BSC?

_____ Weak, should be discouraged

_____ Good, better than many

_____ Very good, no reservation at all


By initialing below, I attest that the information provided is complete and accurate to the best of my knowledge:

Initials: ______Full Name: ______

Title: ______Organization: ______

Complete Address: ______Work Phone: ______

Would you like to be added to BSC’s online mailing list (unsubscribe capability enabled)?

_____ Yes, please._____ No, thank you._____ Thanks! I already receive it.

Would you like to have a BSC representative speak to your organization?

_____ Yes, please._____ No, thank you._____ Thanks! I’m already in contact.

Please submit to .