Reference Form Before Beginning TO THE PERSON COMPLETING THIS FORM: You need to be over 21 years old, cannot be a relative, and must have known the applicant for at least one year. If you are not sufficiently acquainted with the applicant to give your appraisal, please contact the applicant. Please answer the following questions carefully. General Information Name of Applicant (required) First name (required) Last name (required) Email address (required) Phone number (required) How long have you known the applicant? In what capacity? As far as you know, has s(he) been born again by faith in Jesus Christ? YesNo Comments: Has s(he) attended church regularly? Participated in church activities? Done any Christian Service? If so, list: Does s(he) come from a Christian home? A well-disciplined home? Receive encouragement at home? Is s(he) inclined to receive instruction? Yield to discipline? Does s(he) have any significant limitations in the physical, mental, emotional, or social realms? If so, explain: Does s(he) have any special talents or abilities? (Please list) Have you noted any particular weaknesses? (Please list) Has s(he) to your knowledge ever been disciplined or dropped from school? Released from employment? If so, explain: Have you observed anything that would be questionable about his/her moral life? If so, explain: Have you ever known the applicant to use intoxicating beverages? Tobacco? Drugs? If so, explain: Have you any reason whatsoever for lack of confidence in the applicant? If so, explain: What degree of success as a college student would you predict for this applicant? SuperiorExcellentAbove AverageAverageBelow AverageFailure Personality and Character Assessment Check the rating that indicates your estimate. Additional remarks for fuller explanation will be most helpful to us. Spiritual Life Vital & ContagiousRich & Growing in MaturityAverageGenuine, but not ContagiousCharacterized by Immaturity Additional Comments: Initiative Anticipates Needs: ResourcefulShows Good InitiativeAverage – Occasional InitiativeRequires Some DirectionRequires Constant Supervision Additional Comments: Cooperation Works Well With OthersWorks Well Under OthersCooperative Only Under PressureNot Cooperative Additional Comments: Judgment DiscerningGood Common SenseAveragePoor Sense of Values Additional Comments: Tactfulness Very Sensitive to OthersUsually CourteousSometimes UntactfulBlunt, OutspokenInsensitive to Others Additional Comments: Responsibility Capable of Much ResponsibilityThoroughly DependableUsually ReliableShows Some DependabilityIrresponsible, Careless Additional Comments: Industry Seeks Additional WorkGoes Beyond What Is RequiredCooperativePerforms Assigned TasksNeeds ProddingDifficult to Handle Additional Comments: Acceptance By Others Sought After By OthersWell Liked By OthersLiked By OthersJust Tolerated By OthersAvoided By Others Additional Comments: Leadership Inspiring and Successful LeaderGood LeadershipAssumes Occasional LeadershipTries, But Usually Fails at LeadershipAlways a Follower Additional Comments: Emotional Stability Exceptionally StableWell BalancedUnresponsiveHigh Strung, but ControlledExcitable-Easily Upset Additional Comments: Personal Appearance Neat AppearanceAverage AppearanceCareless in Dress Additional Comments: Your Electronic Signature Please Print Your Name Below