confidential

Reference for Bahá’í Youth Year of Service

To be completed by the Applicant:

Name_______________________________________________________________________________ rMale rFemale

Street Address_______________________________________________ Town____________________________________

State____________________________________ Country_______________________________ Post Code_____________

Phone___________________________ Fax_____________________________ E-Mail_____________________________

To be completed by the Local Spiritual Assembly, or appropriate Bahá’í Institution:

Full name of Institution_________________________________________________________________________________

Mailing Address_______________________________________________ Town____________________________________

State____________________________________ Country_______________________________ Post Code_____________

Phone___________________________ Fax_____________________________ E-Mail_____________________________

Describe the Applicant’s experience as a Bahá’í, including committees and Assemblies of which he/she was a member, her/his pioneering or travel-teaching service, and her/his role in the community as a Bahá’í. Attach additional sheets if necessary.

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Does the Applicant have any special qualifications or talents that can be of use to the Bahá’í Community? rYes rNo

If so, please explain____________________________________________________________________________________

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Please add any further comments on a separate sheet of paper.

Is the Applicant a Bahá’í in good standing? rYes rNo

Does your Bahá’í Institution feel that the Applicant can and will serve the Cause of God to the best of his abilities? rYes rNo

After careful and thorough consultation, we, (print name of institution) ______________________________________________ ,

rRecommend without Reservation rRecommend with Reservation rDo Not Recommend

that the Applicant undertake a Bahá’í Youth Year of Service for the reasons stated above.

Signature__________________________________________ Date______________________________________________

Official Capacity _____________________________________