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