Pastoral Reference Form – Chaplaincy CHAPLAINCY PASTORAL REFERENCE FORM Name of Pastor Phone Email Name of Church Name of Student Candidate * INSTRUCTIONS FOR PASTOR. Due to the very personal and ethical nature of Chaplaincy and the responsibilities associated with this ministry, it is necessary for Hope College to ask the following questions to assist the applicant in identifying if Chaplaincy is a suitable ministry choice for them. How long have you known the student candidate? * How often does the student candidate attend church? * All services and midweek group/s At least one service a week Once or twice per month Less than once per month Rarely attends Should the applicant be successful and enrol in Chaplaincy training, is your church able to provide the applicant with volunteer community based ministry opportunities where they can gain chaplaincy skills and experience? Yes No If yes, what ministry opportunities are available?If yes, what ministry opportunities are available? If no, can you recommend another organisation that may provide such opportunities?If no, can you recommend another organisation that may provide such opportunities? In your opinion, would the applicant be spiritually, physically and emotionally capable of performing the requirements of Chaplaincy and able to abide by the Chaplains’ Code of Professional Conduct. * Yes No CHAPLAINS’ CODE OF PROFESSIONAL CONDUCT - Australian Christian Churches The Code of Professional Conduct requires Endorsed Chaplains/Team Chaplains to be personally responsible and accountable for their practice and conduct as provided by this Code. Members are required to: Be a committed Christian who holds to the Apostles Creed and the doctrines held by their relevant denomination. Maintain the highest ethical standards in their own personal life. Be personally accountable for their professional conduct to their employing authority and/or Church authority. Maintain the highest standards of professional competence and integrity in the pastoral, spiritual and religious care of recipients. Exercise the greatest sensitivity and discretion in matters of confidentiality, privacy and respect for others. Continue to undertake professional development, enhancing their chaplaincy skills; including attendance at Chaplaincy Australia Conferences and regional meetings. Co-operate fully with industry professionals, Chaplaincy colleagues and representatives of the Church in providing holistic care to others. Respect at all times the religious faith, practice and belief systems of clients. Provide for the appropriate pastoral, spiritual and religious services required by recipients. Ensure that no personal action or omission, within their own area of responsibility, is contrary to the highest standards of care or to the welfare of recipients. Be an active member of a local Church fellowship. Meet with their Senior Minister (or their appointee) periodically to discuss their ministry and to ensure that accountability and encouragement is being received. Engage in regular mentoring/supervision that contributes to your own personal, spiritual and professional development. Further Comments Is there any information that you feel needs to be taken into consideration in respect of this application? Yes No If yes, please complete On the basis of the above, the applicant is: Strongly Recommended Recommended Recommended with reservations Not Recommended Regarding the applicant’s access to the information on this form (choose one): I give permission for the student applicant to read this form if required The information on this form is to remain CONFIDENTIAL, and not to be accessed by the student applicant * If you do not recommend the applicant, Hope College will advise the applicant that their reference was not supported and give the applicant opportunity to seek another reference. As Pastor, I affirm that I have personally completed this reference on behalf of the student applicant. * Yes No Date Alternative Methods to submit this reference Person: Hope Building 4, 175 Varsity Parade, Varsity Lakes, Qld 4227 Australia Phone +61755510269 Fax: +61756417810 Print then Post to: Box 35 Varsity Lakes Qld 4227 Australia Email: firstname.lastname@example.org If you are human, leave this field blank.