Adult Reference for New Applicant

The following reference is confidential and information contained within will not be shared with the applicant.

Applicant’s Name *

Today's Date

In what capacity and for how long have you known the applicant?

In your opinion, what are the leadership qualities of the applicant

The applicant is a natural leader and willingly accepts leadership roles

The applicant is a natural leader, but accepts leadership roles reluctantly

The applicant is not a leader, but integrates well with others

The applicant is not a leader and has difficulty integrating with others

In your opinion, how does the applicant handle responsibilities

The applicant takes initiative and is very responsible

The applicant usually takes responsibility for assigned work

The applicant usually avoids accepting responsibility for work

The applicant is irresponsible

What is the applicant’s personal faith experience, as you perceive it

The applicant seems disinterested in personal faith

The applicant seems passively interested in personal faith

The applicant seems to be growing in faith

In your opinion, does the applicant have emotional issues? If yes, please explain.

Have you ever know the applicant to smoke, drink alcohol, use drugs, or steal? If so, please elaborate

Please comment on the applicant’s relationship with his/her parents

In your opinion, what qualities in the applicant need improvement

What qualities of this student endear him/her to you personally

In what ways has the applicant had an effect or influence on your life

In your opinion, what does Vine Academy have to offer this applicant that would meet his/her needs

What qualities does the applicant have that would be a positive contributions to Vine Academy

Please add any further information that you think would be helpful to us.

May we contact you by phone for additional information

Yes

Your Name *

Phone

Signature

Address

Apt, suite, etc.

Country

City

State

Zip code