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 *

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 *

Intellect *

JUDGMENT *

Service *

Industriousness *

Relation to Church *

Healthy Lifestyle *

Sociability *

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 *

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