Pastor Reference Form

Pastor, Youth Pastor, Elder, or Deacon

*Denotes Required Field * Title

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, and return as soon as possible.

* Student's First Name

* Student's Last Name

* How long have you known the applicant? (A minimum of 1 year required)

* Relationship to the applicant

Pastor
Elder/Deacon
Other

* What is your relationship to the applicant?

* Do you believe that the applicant has a relationship with Jesus Christ?

* Describe the applicant's home life/background.

* What is the applicant's reputation in the community (respected, rebellious, leader, etc.)?

* To your knowledge, does the applicant indulge in any habits that would hinder his/her spiritual growth or testimony (alcohol, drugs, tobacco, other)?

* Please explain

* How would you rate the applicant's ability for college level academic work?

above average
average
questionable
no knowledge

* Are you aware of any learning difficulties?

* Please explain

* Are you aware of physical weaknesses or emotional problems that would hinder the applicant from being a diligent student in the dorm and classroom?

* Please explain

* Please indicate you recommendation of the applicant to PRBI.

highly recommended
recommended
recommended with reservations
not recommended

* Please explain

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

* Respect for Authority

* Initiative and Perseverance

not able to observe
needs constant supervision
needs frequent prodding
fulfills ordinary responsibilities
self-motivating

* Mental Alertness

* Financial - Integrity and Honesty

* Emotions

* Judgment and Common Sense

Relationships (select several):

reserved

tendency to be alone

domineering

aloof

cold

friendly

cautious

sense of humour

outgoing

antisocial

warm

loner

shy

empathetic

Other pertinent information we should know about the applicant:

* Your First and Last Name

* Full Address

* Phone Number ( ) -

* Email

I would like to receive the PRBI Trumpet magazine (3x per year)

Via email
Via snail mail

* Release of Information

I authorize the release of the disclosed information.
I do not authorize the release of the disclosed information. (Only select if you disagree with the statement below.)

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.

Pastor Reference Form

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