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Adult Christian Friend (21+) Reference Form

Adult Christian Friend (21 or older)

*Denotes Required Field

The information given in this Character Reference is used for the application process, roommate placement, as well as allowing us to understand the needs of the applicant. Please answer each question to the best of your ability.

If you do not have time to complete this form in one sitting, you can "Save Partial Response" and complete it within 2 weeks.

  • Yes
  • No
  • Yes
  • No
  • Yes
  • No
  • above average
  • average
  • questionable
  • no knowledge
  • Yes
  • No
  • Yes
  • No
  • highly recommended
  • recommended
  • recommended with reservations
  • not recommended

Please rate the applicant on the items below by selecting the appropriate description.

  • not able to observe
  • disrespectful
  • critical
  • respectful
  • shows deference to others
  • not able to observe
  • needs constant supervision
  • needs frequent prodding
  • fulfills ordinary responsibilities
  • self-motivating
  • not able to observe
  • sluggish
  • learns slowly
  • learns with reasonable application
  • learns easily
  • not able to observe
  • indifferent and lazy
  • works in spurts
  • usually fulfills obligations
  • dependable
  • not able to observe
  • stoic and unresponsive
  • moody and temperamental
  • copes well
  • handles stress well
  • not able to observe
  • lacks ability
  • poor judgement
  • fair judgement
  • shows discernment

Relationships (select several):

 ) -
  • Via email
  • Via snail mail

Release of Information:

This information will be held in confidence by Peace River Bible Institute and will not be released to anyone (other than appropriate employees or representatives of Peace River Bible Institute), without your permission, or in the absence of your permission, a Court Order, Subpoena or laws requiring the disclosure of such information.

  • I authorize the release of the disclosed information.
  • I do not authorize the release of the disclosed information.

Thank you so much for filling out this reference form!

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