Serving as a reference

We ask that the person who completes this reference form is a pastor or member of the clergy, a church staff member, a counselor, or a teacher who knows the candidate sufficiently. Please fill out one reference form per candidate. The purpose of this reference form is to assist us with evaluating a participant's candidacy and the placement of each person in a group of peers where he/she will benefit the most.

Your written answers below can be brief. The information that you provide about the applicant is meant to be private and will remain confidential to us. Please note that optional fields are marked with an asterisk. Thank you for taking the time to serve as a reference and for providing this information so that we can prepare for their best Emmaus experience.

Reference form

Applicant information

Your pilgrim's information

First name:Last name:Gender:MaleFemale

Sponsor's information

Please see the email you were sent in order to fill in the information below

Sponsor's first name:Sponsor's last name:Sponsor's email:

Reference information

Authorization

Your signature:Today's date:

As a reference (the person filling out this online document), you are either a pastor, member of the clergy, a church staff member, a counselor, or a teacher who knows this candidate sufficiently in order to make the assessment above. By placing your full legal name in the box above and by dating this online form, you are authorizing us to use this information solely for the purpose of evaluating the applicant's candidacy and how to best place this person in a small group of peers on their Emmaus weekend.

Thank you! Your reference form has been received!

We have just sent an email that notifies the applicant's sponsor that you have successfully submitted this form. A "pilgrim" cannot attend a the Walk to Emmaus without at least one reference so we appreciate the time you have taken to submit a reference form for this applicant.

If you have any questions or concerns that we can address for you about the Walk to Emmaus, please feel free to contact any of our board members directly or you can send an email to:

centralcarolinasemmaus@gmail.com

and we will be happy to respond. Thanks!

- The Central Carolinas Emmaus Board

Oops! Something went wrong while submitting the form. Please make sure all required fields are completely filled out and then try to resubmit. Please note that optional fields are marked with an asterisk.