Pastoral Reference Form
Elim Bible Institute and College
Your Phone Number
Street Address Line 2
State / Province
Postal / Zip Code
Name of applicant
How long have you known the applicant?
What is your relationship to the applicant?
What is the applicant's influence on his/her peers?
recommended with reservation*
Has the applicant made a meaningful personal commitment to Jesus Christ?
I don't know*
Indicate the applicant's level of involvement in the life and work of the church (check all that apply):
Willing to help
Are there any negative family factors which might affect the applicant's success at Elim?
Is there any other information you feel would help in our evaluation of the applicant, or, if accepted, to help this student succeed?
Should be Empty: