Church Reference
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Applicant's first name
Applicant's middle name
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Applicant's last name
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Applicant's city
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Applicant's state
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Applicant's high school
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How long and in what capacity have you known the applicant?
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How well do you know the applicant? Very well Fairly well Casually Just by name / sight
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To the best of your knowledge, has the applicant made a sincere commitment to Jesus Christ? Yes No
Comments
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Please rate the applicant in the following areas:
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Initiative / Motivation Excellent Above average Average Below average Poor Unknown
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Leadership Ability Excellent Above average Average Below average Poor Unknown
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Concern for others Excellent Above average Average Below average Poor Unknown
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Gracious character Excellent Above average Average Below average Poor Unknown
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Humility Excellent Above average Average Below average Poor Unknown
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Emotional stability Excellent Above average Average Below average Poor Unknown
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Moral character Excellent Above average Average Below average Poor Unknown
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Student of the Word Excellent Above average Average Below average Poor Unknown
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Positive outlook on life Excellent Above average Average Below average Poor Unknown
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Anticipated academic achievement Excellent Above average Average Below average Poor Unknown
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Do you know of any areas where the applicant might need special attention?
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Northwestern College seeks students who live out their Christian faith and desire instruction within a biblical worldview. To your knowledge, would the desires, beliefs and conduct of this applicant be in line with this goal? Yes No
If no, please explain.
What else would you like us to know about this person?
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Recommendation Highly recommend Recommend Recommend with reservations Would not recommend
Comments
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I would like to speak with someone regarding this applicant: Yes No Call me if you wish
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Would you like a packet of Northwestern College literature sent to the church for the youth group? Yes No
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Would you like someone to speak to your youth group and / or parents about preparing for college? Yes No
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Would you like information about the Office of Church Relations at Northwestern? Yes No
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Reference's name
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Title
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Church name
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Denominational affiliation
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Church address
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City
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State
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Zip
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Phone
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E-mail address
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Senior high youth pastor / leader
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I certify that the information I have provided is true and complete. I also certify that I am indeed the reference identified above and the sole author of all information provided.
