Pastoral Reference Form
Elim Bible Institute and College
Your Name
First Name
Last Name
Your Phone Number
-
Area Code
Phone Number
Your Email
example@example.com
Church Name
Church Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of applicant
How long have you known the applicant?
How well?
Very well
Casually
By name/sight
What is your relationship to the applicant?
What is the applicant's influence on his/her peers?
Positive
Neutral
Negative
Unknown
Applicant is:
highly recommended
recommended
recommended with reservation*
not recommended*
*Please Explain:
Has the applicant made a meaningful personal commitment to Jesus Christ?
Yes
No*
I don't know*
*Please Explain:
Indicate the applicant's level of involvement in the life and work of the church (check all that apply):
Attends regularly
Cooperative
Interested
Involved
Attends irregularly
Distant
Enthusiastic
Willing to help
Are there any negative family factors which might affect the applicant's success at Elim?
Yes*
No
*Please Explain:
Is there any other information you feel would help in our evaluation of the applicant, or, if accepted, to help this student succeed?
Signature
Submit
Should be Empty: