Grand Rapids Bridge Year Reference Form Step 1 of 5 0% General InformationYour Name First Last Position/Title Employer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Phone NumberYour Email Grand Rapids Bridge Year Applicant's Name First Last Questions about the applicantHow well do you know the applicant?Very WellWellCasuallyHow many years have you know the applicant?Less than 1 year1-3 years3-5 years5-10 years10 years or moreIn what context have you gotten to know the applicant?Personality QuestionsPlease check all that applyPersonality avoided by others tolerated by others accepted by others liked by others sought after by others good control in difficult situations Comments:Intelligence learns and thinks slowly average mental ability alert, has a good mind intelligent, makes thoughtful analysis brilliant, exceptional capability CommentsResponsiveness slow to sense how others feel reasonably responsive understanding and thoughtful accurately aware of others responds with unusual insight CommentsLeadership makes no attempt to lead tries but lacks ability has some leadership skills growing in natural leadership unusual, exceptional leadership CommentsEmotional Stability somewhat over-emotional inclined to be apathetic rapidly shifting moods well balanced CommentsTeamwork frequently causes friction prefers to work alone knows how to follow works well with others most effective working in a team CommentsSpiritual Maturity immature faith has made basic commitment somewhat moralistic over-emotional genuine and growing faith exceptional insight and discipline Comments How would you rate the applicant in the following:IndustryHard WorkerAverageSlowReliabilitymeets obligationsaverageneglects obligationsFlexibilityopen to changeaverageunyieldingChristian Characterwell balancedaverageunstableDispositioncheerfulaveragepassivePunctualitypunctualaverageoften lateFinancial Responsibilityhonors obligationsaverageneglectfulChristian ServicededicatedaveragecasualHealthactive lifestyleaveragerelatively inactiveJudgement / Decision Makingmakes wise decisionsaverageacts impulsivelyComments from the previous questions Answer of the following questions to the best of your knowledgeDoes he/she display high moral standards?YesNoNACommentsIs he/she welcoming of people from different backgrounds or cultures?YesNoNACommentsOverall, what do you consider to be the applicant’s strongpoints (skills, character, abilities)?Please comment on the applicant’s family background, if known.What could this experience do to aid in the applicant’s personal development?Please add any relevant remarks (i.e. medical, psychological, drug or alcohol related, or any life situations we should know more about)Would you recommend the applicant for acceptance into Grand Rapids Bridge Year?YesNoYes, but with reservationsSince you said "no" or " you have reservations", can you explain them to us?** By checking this box, I certify that the mission school applicant posesses the qualities indicated above. Check this box if you'd like to receive more information about Bridge Street Ministries One last chance to review your submission: {all_fields} Δ
