Reference Form Reference Form Student's Name * First Student's Last Name * Last Your Name * First Last Name * Last Email * Phone * Address * City * State --Select--AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Postal Code * Country * United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongoCosta RicaCôte d‘IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Please rate the applicant on a scale of 1 to 5 for each of the points below. 1 = Poor, 5 = Excellent 1. In your judgment, what is the student’s strength of character? * 1 2 3 4 5 2. Rate how well the student lives up to church standards * 1 2 3 4 5 3. How trustworthy is the student in terms of honesty? * 1 2 3 4 5 4. What level of cooperation will the student be willing to give? * 1 2 3 4 5 5. What Christian influence will the student have on others? * 1 2 3 4 5 6. Does the student practice good health habits? * 1 2 3 4 5 7. Does the student have respect for authority? * 1 2 3 4 5 8. Does the students personal appearance reflect maturity? * 1 2 3 4 5 9. Does the student conduct themselves appropriately in the company of the opposite sex? * 1 2 3 4 5 10. How would you rate the students level of academic performance? * 1 2 3 4 5 11. How responsible is the student at his/her age? * 1 2 3 4 5 12. Does the student respect and get along with his/her parents? * 1 2 3 4 5 13. Does the student keep positive friends most of the time? * 1 2 3 4 5 14. Does the student stay out of trouble; gossip, conflict, etc. * 1 2 3 4 5 15. How ambitious and hard working is the student? * 1 2 3 4 5 16. Does the student have leadership qualities? * 1 2 3 4 5 17. Overall how do you think the student will perform in a Christian school * 1 2 3 4 5 If you are human, leave this field blank.
