Reference Form – Harbert Hills

Student's Name *

First

Student's Last Name *

Last

Your Name *

First

Last Name *

Last

Email *

Phone *

Address *

City *

State

State/Province

Postal Code *

Country *

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? *

2. Rate how well the student lives up to church standards *

3. How trustworthy is the student in terms of honesty? *

4. What level of cooperation will the student be willing to give? *

5. What Christian influence will the student have on others? *

6. Does the student practice good health habits? *

7. Does the student have respect for authority? *

8. Does the students personal appearance reflect maturity? *

9. Does the student conduct themselves appropriately in the company of the opposite sex? *

10. How would you rate the students level of academic performance? *

11. How responsible is the student at his/her age? *

12. Does the student respect and get along with his/her parents? *

13. Does the student keep positive friends most of the time? *

14. Does the student stay out of trouble; gossip, conflict, etc. *

15. How ambitious and hard working is the student? *

16. Does the student have leadership qualities? *

17. Overall how do you think the student will perform in a Christian school *

Title

Date *

Signature *