CHARACTER REFERENCE FORM Form also available online at www.WesternMennoniteSchool.org/references Part 1: To be completed by the applicant Name of applicant: Home phone
Date: Current grade: Email:
Part 2: To be completed by reference Your name:
Relationship to student:
How long have you known this student: Home address: Street
City
Home phone
State
Zip
Email:
Circle the words which best describe this student: joyful friendly rebellious flexible creative
vivacious easy-going procrastinates responsible prompt
Please rate the following: Academic ability Social adjustment to peers Attitude toward authority Family support Christian commitment Leadership
loud neat proud loyal leader
loving quiet tolerant dramatic active
Very High
forgiving articulate lethargic organized shy
High
cheerful spiritual defensive studious
Average
devoted congenial humble flexible
Low
sociable follower clown sincere
Very Low
meek careless tender troubled
Unknown
What special talents, skills, or leadership qualities would this student bring to Western Mennonite School?
In what areas of personality and performance would you like to see growth? Do you recommend this student for acceptance at Western? Yes / No Why? Please add any additional comments which might be helpful. Signature: ___________________________________________________ Date: Please return to: ADMISSIONS, WESTERN MENNONITE SCHOOL 9045 Wallace Rd NW, Salem, OR 97304
THANK YOU FOR YOUR TIME AND CARE ALL RESPONSES WILL BE KEPT CONFIDENTIAL