Student's Name * First Student's Last Name * Last Your Name * First Last Name * Last Email * Phone * Address * City * State --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Postal Code * Country * United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d‘Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe 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 Title Date * Signature * Clear If you are human, leave this field blank.