Reference For Students Applying to Grades 9-12
South Haven Christian School
Today's Date
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Month
-
Day
Year
Date
Student Applying for Admission
First Name
Last Name
How long have you known the student?
Does the student attend church regularly?
Yes
No
Unsure
Does the student regularly participate in church activities?
Yes
No
Unsure
Does the student come from a Christian home?
Yes
No
Unsure
Does the student come from a well-disciplined home?
Yes
No
Unsure
Is the student inclined to receive instruction?
Yes
No
Unsure
Does the student yield to discipline?
Yes
No
Unsure
Does the student interact well with others?
Yes
No
Unsure
Does the student have any significant limitations in the physical, mental, emotional, or social realms?
Yes
No
Unsure
If so, please explain.
What are some strengths you have recognized in this student?
Has the student, to your knowledge, ever been disciplined, suspended, or expelled from school?
Yes
No
If so, please explain.
Have you observed anything that would question this child's ability to succeed in a Christian school?
Yes
No
If so, please explain.
Have you ever known the student to drink alcoholic beverages, use tobacco products, or illegal drugs?
Yes
No
If so, please explain.
Would you want your own child associating with this student?
Yes
No
Why, or why not?
Please add any additional comments.
The fields below relate to the person completing this form.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Relationship to Applicant
Signature
Submit
Should be Empty: