GARDNER COLLEGE
– A Centre for Christian Studies –
Camrose, Alberta
CONFIDENTIAL PERSONAL REFERENCE FORM
FORM B
This form is to be completed by the applicant’s Pastor, a teacher, personal friend, or employer who can give adequate character reference.
Name of applicant ___________________________________Program applying for ______________________
Address ________________________________________________________________
City ________________________________Prov. ______________________ Postal Code ________________
Person you have selected to complete this form:
Name______________________________Position______________________________SECTION ABOVE TO BE COMPLETED BY APPLICANT
The student named above is applying for admission to Gardner College. Your appraisal is important in determining probable success in college. Please fill in this form as completely as possible and mail it directly to us. Attention Registrar.
Please rate the applicant in these qualities by placing a check in the appropriate place.
| Poor | Below Average | Average | Above Average | Excellent | Unknown | |
| Energy and Initiative | ||||||
| Independence | ||||||
| Leadership skills | ||||||
| Self-confidence | ||||||
| Health self image | ||||||
| Concern for others | ||||||
| Reaction to criticism | ||||||
| Reaction to setback | ||||||
| Respect toward authority | ||||||
| Appearance and grooming | ||||||
| Student’s level of social readiness for college | ||||||
| Writing skills | ||||||
| Oral communication | ||||||
| Academic ability | ||||||
| Motivation |
PLEASE USE ADDITIONAL PAPER IF NECESSARY TO COMPLETE THIS FORM
Are you aware of any physical or emotional situation concerning this applicant which the college should be aware?
If yes, please explain.
Please list what you know to be the applicant’s strengths and weaknesses.
I recommend this applicant for admission to Gardner College. [ ] Yes [ ] No
If no, why not?
Do you know of any additional information which should be shared with the college in relationship to this applicant?
Your relationship to applicant
______________________Length of time acquainted with applicant _____________________
Date ________________* May we contact you for further references regarding this applicant? [ ] Yes [ ] No
*Your Signature___________________________________________
* I affirm that the above information contained in this document is true and complete to the best of my knowledge.
Please mail CONFIDENTIALLY to:
The Registrar
Gardner College
4707 – 56 Street
Camrose, Alberta T4V 2C4
Your Address_____________________________________________________
City _____________________ Prov. ______________Postal Code____________ Phone ( )___________