To be completed by an adult, other than a family member, who can provide a personal reference. This reference will remain confidential and will not become part of the applicant’s permanent record. If you prefer to speak to a school official, contact the admissions director at 574 534-2567. Your comments are important to us and we thank you for your cooperation.

Reference Information

Applicant Name: *

Name of student applying to Bethany Christian Schools

Name of Personal Reference: *

Person providing the reference

Relationship to Applicant:

Length of Acquaintance:

Your Phone Number: *

Your Email: *

Required so that a Bethany Christian School's official can contact you to verify the authenticity of this submission.

Applicant Information

Evaluate this applicant by checking the appropriate box:

Social Adjustment:

Unknown

Low

Average

High

Church Involvement:

Unknown

Low

Average

High

Self-confidence:

Unknown

Low

Average

High

Motivation:

Unknown

Low

Average

High

Creative Qualities:

Unknown

Low

Average

High

Leadership:

Unknown

Low

Average

High

Concern for Others:

Unknown

Low

Average

High

Religious Faith: Describe the applicant's religious faith and relationship to a local congregation:

Lifestyle Expectations: Bethany asks students to commit themselves to contribute to a positive Christian atmosphere and to respect others, take good care of school property, and refrain from using tobacco, alcohol, and illegal drugs.

Does the applicant hold values or exhibit behaviors that comply with the above lifestyle expectations?:

Yes

No

Unsure

Additional Comments: Please add any comments that would be helpful to school personnel as they serve this student at Bethany:

Recommendation: Indicate your overall recommendation regarding admission of this applicant: *

I recommend with confidence

I recommend with reservation

I cannot recommend

If you cannot recommend with confidence, please state reason(s) below:

Thank you for your time, honesty, and insight

Verification: *

I affirm that all information contained herein is accurate to the best of my knowledge and that I am the Personal Reference named above.