Pastoral Reference Form

To the best of your knowledge, is the applicant born again? YesNo

If no, please explain below

Please evaluate the applicant in the following areas by marking:

5 - outstanding 4 - above average 3 - average 2 - below average 1 - poor N - no information

What outstanding abilities would you say the applicant possesses?

Does the applicant have any personal habits which would disqualify him from becoming an acceptable student? YesNo

Has the applicant been disciplined or dismissed from another college or university, or local church? YesNo

Do you recommend this applicant for admission to NTCGS? YesNo

If yes, please check one: with enthusiasmwith reservationwith confidencewith reluctance

Please use this space to give any additional information from above questions or other information which is pertinent.

Name of Reference:

Email Address:

Signature:

Date: