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Student Reference Form
*
Indicates required field
Applicants Name
*
The
above
person
has
applied
at
Eden
Valley
Institute
and
has
given
your
name
as
a
reference.
Your
careful
and
honest
evaluation
is
valued
and
necessary
for
us
to
make
a
final
decision
regarding
this
individual.
This
referral
form
will
be
kept
strictly
confidential.
Since
this
form
must
be
on
file
before
acceptance
can
be
considered, your prompt completion of this form is appreciated
.
Thank
you
very
much
for
your
assistance
and
for
your
time
in
providing
us
with
your
honest
appraisal
of
this
applicant.
l. How long have you known the applicant?
Years Known
*
What is your relationship to the applicant?
Reference Relationship
*
Teacher
Pastor
Work Supervisor
Acquaintance
Other
2. What are the applicant's greatest strengths?
*
3. In what ways might the applicant need to experience positive growth?
*
4. Do you have any information about the applicant's life or background which you believe might be of particular concern to Eden Valley Institute?
*
5. If you would be willing for us to contact you further about the applicant, please provide a telephone number where you may be reached during normal business hours:
Phone Number
*
6. Additional comments (optional)
*
7. Please indicate the number below which best describe the applicant for each category of evaluation. (Note: "5" indicates the applicant is most like the characteristics on the left side, and "1" the characteristics on the right side. "4," "3," and "2" show moderate association with either side. If you have inadequate information concerning any, please indicate so my choosing n/a)
A. Spirituality
B. Intellect
C. Judgement
D. Service
E. Industriousness
F. Relationship to the Church
G. Healthy Lifestyle
H. Sociability
strong, stable, growing
vigorous, creative, learning
sound, careful, teachable
compassionate, unselfish
diligent, thorough
loyal, supportive
conscientious, healthy
secure, outgoing, friendly
Spirituality
*
Select one
5
4
3
2
1
n/a
Intellect
*
Select one
5
4
3
2
1
n/a
JUDGMENT
*
Select one
5
4
3
2
1
n/a
Service
*
Select one
5
4
3
2
1
n/a
Industriousness
*
Select One
5
4
3
2
1
n/a
Relation to Church
*
Select One
5
4
3
2
1
n/a
Healthy Lifestyle
*
Select One
5
4
3
2
1
n/a
Sociability
*
Select One
5
4
3
2
1
n/a
immature, shaky, stagnating
slow, unmotivated, self-stisfied
rash, impulsive, headstrong
indifferent, self-centered
lazy, incompetent
critical, divisive, distant
uninformed, careless
shy,introverted, unsocial
8. I am acquainted with the principles and policies which characterize life at Eden Valley Institute.
Acquainted with Eden Valley
*
Yes
No
9. Considering the applicant for acceptance at Eden Valley Institute:
*
I recommend without reservation
I recommend with some reservation
I do not recommend under the present circumstances
I do not recommend under any circumstances
Reference Name
*
First
Last
Position or Title
*
Date
*
Submit
HOME
ABOUT US
Newsletter Subscription
DEPARTMENTS
LIFESTYLE
>
Success Stories
Lifestyle Program
Program Dates
Rates and Payment
Follow-Up Form
Lifestyle Application Form
EDUCATION
>
Medical Missionary / Evangelism
Agricultural Program
Student Reference Form
COUNTRY STORE
FARM
>
Eden Valley Farm
>
Eden Valley Farm Site
Farm Newsletter Sign-up
Farm Photos
MEDIA
>
Photo Gallery
Eden Valley Cookbook
Faith Ventures
EDEN VALLEY KIOSK
APPLY
Internship Application
Volunteer Application
>
Volunteer Opportunities
Medical Missionary Evangelism Training Program Application
Agricultural Student Application
Reference Form
DONATE
CONTACT