Loucon Counselor Confidential Reference Form

Counselor Applicant's Full Name:
Name of Camp (not Loucon):
Dean's Name (leader of the camp):

[COUNSELOR] has given your name as a reference in applying for a summer counseling position at Loucon Training & Retreat Center, a Christian camp for children and youth operated by the Kentucky Conference of the United Methodist Church. Your critical and confidential evaluation will be of great help to us in selecting the best possible counselors. We are looking for people who are mature, loving, enthusiastic, responsible, and who are of good Christian character. They should possess the ability to get along with children, youth, and adults. It is important that each counselor work well with people and have the physical stamina for outdoor living. They will be role models and caretakers for the children and/or youth whom are placed under their responsibility.

Please thoroughly answer the following questions and then mail this reference form to the address listed at the end of this form.

How Long, and in what capacity have you known the applicant?

Would you allow the applicant to be responsible for your children in a camping situation?

Yes No

Please Explain:

Have you been witness to the applicant interacting with children and/or youth?

Yes No

If so, Please evaluate their performance:

What qualities does the applicant possess which you think would benefit them in a counseling role?

Please elaborate:

Do you feel/think this applicant is spiritually mature enough to share his/her faith with the youth and children at Loucon?

Yes No

Please elaborate:

If the applicant has worked for you, would you be willing to rehire them?

Yes No N/A


In your opinion is the applicant physically able to enjoy a summer in the outdoors in the Kentucky climate?

Yes No

Please explain:

How would you describe the applicant's leadership abilities?

Do you know of any characteristics that would negatively affect the applicant's ability to work with children and/or youth?

Yes No

If so, please describe:

Do you have any knowledge that the applicant has ever been convicted of a crime?

Yes No

If so, please describe:

Please rate the applicant in the following areas to the best of your knowledge. Check the box that best describes the applicant.

Excellent Good Average Fair Poor Unknown
Ability to relate to others
Common Sense
Personal Habits
Self Discipline
Sense of Humor
Ability to work w/children/youth
Spiritual maturity

Please rate the applicant as a potential counselor:

Exceptionally Strong
Above Average
Below Average

Any Additional comments on how you rated the applicant or about anything you feel/think is pertinent to their performance as a counselor are most welcome.

Your Name:
Phone #:
I promise that I have filled out this form truthfully and to the best of my ability and knowledge.


(270) 242-7160
8044 Anneta Road   |   Leitchfield, KY   |   42754