Please mail or fax this form to
Pastor’s Reference Form
GILBERT BIBLE SCHOOL
P.O. BOX 292168
Davie, FL 33329-2168
Name of prospective student _____________________________________________ Age_____________________
Address:
_________________________________________________________________________________
(Street and Number) (City) (State) (Zip)
You will recognize the need for great care in receiving men and women into a Christian school.
In order to make an intelligent selection and learn something about the prospective student’s
needs beforehand, we will appreciate your candid and careful answers. Your reply will be treated
in the strictest confidence.
A. Please check the following statements which represent your opinion of the applicant’s
behavior and attitudes. Additional information may be attached to this form.
1. MENTAL ABILITY __ Quick comprehension __ Average __ Slow
2. SERIOUSNESS OF PURPOSE __ Purposeful __ Limited __ Vacillating __ Purposeless
3. INDUSTRY __Seeks additional work __ Prepares assigned work __Needs occasional prodding
__needs constant pressure
4. INITIATIVE __ Actively creative __ Self-reliant __ Conforms __ Seldom initiates
5. INFLUENCE __Strongly controlling __ Contributing __Retiring but cooperative __ Passive
6. CONCERN FOR OTHERS __ Deeply & genuinely concerned __Somewhat socially concerned
__ Self-centered __ Indifferent
7. RELIABILITY __Conscientious __Usually dependable __ Somewhat dependable __ Unreliable
8. EMOTIONAL STABILITY __ Exceptionally stable __ Well-balanced __ Excitable
__ Hyperemotional __ Apathetic
9. ADAPTABILITY __Makes good adjustments __ Average __Ill at ease __ Needs development socially
10. SELF-RESPECT:
a) DRESS __ Neat __ Average __ Untidy
b) PERSON __ Clean __ Average __ Careless
c) SPEECH __ Careful __ Indifferent __ Loose
B. Comment briefly on the family and social background of the applicant. ________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________
____________________________
C. Would you recommend the applicant’s admission to GILBERT BIBLE SCHOOL? __ Yes __ No
I have known the applicant for _____ years and believe that (he) (she) possesses the qualities indicated above.
NAME (please print)_______________________________________________________________
SIGNATURE___________________________________________________DATE______________
ADDRESS____________________________________________________________________
CITY___________________STATE_____ZIP____________TEL. ________________________