Discipleship Reference Form - Southwestern College

Reference Form

Thank you for your willingness to serve as a reference for the student applicant. Please answer the following questions about this student.

Thank you for your time. Your knowledge will prove very useful to us as the student moves through the application process. Blessings and Peace!

Student/Applicant Name*

First NameLast Name

What is your relationship to this student and for how long?*

What have been this applicant’s experiences in a church or other setting that might indicate future effectiveness in ministry? (vocational or otherwise)*

Please rate the student’s leadership skill or potential by circling a number on the following scale from 1 to 7, with one being little or none and 7 being a leader with great talent.*

	1	2	3	4	5	6	7

1 is Little/None, 7 is Leader with Great Talent

Then please explain the reasoning behind the number you chose in the space provided above.*

Please give us any other information about the applicant you think is pertinent.*

Your Name*

First NameLast Name

Privacy Policy
The information provided concerning the applicant will be kept confidential. Your information will not be shared with anyone outside of Discipleship Southwestern.

Signature*

Southwestern College is committed to a policy of nondiscrimination on the basis of race, color, gender, age, religion, national origin, handicap, or other nonmerit reasons, in admissions, educational programs or activities, and employment, all as required by applicable laws and regulations. Responsibility for coordination of compliance efforts and receipt of inquiries, including those concerning Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973, has been delegated to the vice president for business affairs, Christy Administration Building, Southwestern College, 100 College Street, Winfield, KS 67156-2499, (620) 229-6000. Southwestern College complies with the Crime Awareness and Campus Security Act of 1990. The yearly report is available from the dean of students upon request. Race and ethnic origin information is voluntary and will not be used in a discriminatory manner.

If you have any questions contact Molly Just at molly.just@sckans.edu or 620-229-6362.

Student Applicant Information

Your Information

Authorization