Student Reference Form

Student's Name:

Appraisal

Your honest and candid appraisal will assist us in making an informed decision regarding this student's compatibility with our spiritual, academic, and physical program. This referral will be kept strictly confidential.

For how long have you known the applicant?

In what capacity have you known him/her?

Please indicate the overall Rating in each category that best identifies the applicant's standing. Check any descriptors from the "Weaker" and "Stronger" columns which apply or add your own descriptors in the comments section. Rating scale: 1 = lowest, 5 = highest.

Has the applicant had any trouble concerning conduct in school or elsewhere? No Yes

If so, what was the nature of the problem?

The applicant has used: drugs alcohol tobacco none to my knowledge.

If you had a child at this school, would you be willing for the applicant to room with him or her? No Yes

Do you believe the applicant really wants to attend Fountainview? No Yes

What has been the home environment (stability, discipline, etc.) of the student?

Please give any further information that would be helpful in evaluating this applicant or in guiding him/her as a student.

To become a member of the student body of Fountainview, the applicant is:

highly recommended
recommended
recommended with reservation
not recommended under the present circumstances
not recommended under any circumstances

Should we need to verify your submission, we ask that you supply a password that will uniquely identify you to our interviewers: