East White Oak Bible Church
Request for References

Name: ________________________________________________________

Please list four references including a pastor who knows you well.  Please also include significant church lay leaders who know you well.  Please exclude relatives, close friends of your own age, etc.  [We will inform you if and when reference forms are sent out.]

Waiver   I waive my right to personally examine references submitted to East White Oak Bible Church.

____________________________________________(signed)  _____________________________(date)


1. Name:
	Address:

	Phone Number:

	Years this individual has known the applicant:  
	In what capacity has this individual known the applicant?


2. Name:
	Address:

	Phone Number:

	Years this individual has known the applicant:  
	In what capacity has this individual known the applicant?


3. Name:
	Address:

	Phone Number:

	Years this individual has known the applicant:  
	In what capacity has this individual known the applicant?


4. Name:
	Address:

	Phone Number:

	Years this individual has known the applicant:  
	In what capacity has this individual known the applicant?