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. If you do not have time to complete this form in one sitting, you can "Save Partial Response" and complete it within 2 weeks. * 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? Yes No * 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)? Yes No * 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? Yes No * 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? Yes No * Please explain: * Please indicate your recommendation of the applicant to PRBI: highly recommended recommended recommended with reservations not recommended * Please explain: * Please explain: Please rate the applicant on the items below by selecting the appropriate description. * Respect for Authority: not able to observe disrespectful critical respectful shows deference to others * Initiative and Perseverance: not able to observe needs constant supervision needs frequent prodding fulfills ordinary responsibilities self-motivating * Mental Alertness: not able to observe sluggish learns slowly learns with reasonable application learns easily * Financial - Integrity and Honesty: not able to observe fails to meet obligations dishonest satisfactory exemplary * Emotions: not able to observe stoic and unresponsive moody and temperamental copes well handles stress well * Judgment and Common Sense: not able to observe lacks ability poor judgement fair judgement shows discernment 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 (4 per year): 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. * Do you consent to the release of this 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! Please wait for a confirmation message before closing this window.
