Character Reference
Thank you for serving as a reference. We appreciate your time and input!
REFERENCE'S CONTACT INFORMATION
Your Name
*
Your Email
Best time to contact you if necessary
Please select one option.
8-12
1-5
early evening
Your Phone
*
STUDENT APPLYING INFORMATION
Future Student's Name
*
How long have you known the applicant?
*
Relationship to Applicant
*
PLEASE TELL US ABOUT THE APPLICANT
Sociability
*
Please select one option.
Avoided by others
Tolerated by others
Liked by others
Well-liked by others
Responsiveness
*
Please select one option.
Slow to sense how others feel
Fairly responsive
Understanding and thoughtful
Responds with Unusual Insight and Consideration
Academic Ability
*
Please select one option.
Learns at a slower pace
Average learner
Alert, good mind
Brilliant and loves to learn
Conflict Management
*
Please select one option.
Seems Passive-Aggressive
Stuffs Frustration
Explosive, Angry, Outbursts
Effectively Works It Out
Teachability
*
Please select one option.
Rigid, Argumentative
Highly Opinionated
Open-Minded
Willing to Receive Instruction
Eager to Receive Instruction
Achievement
*
Please select one option.
Does Only What is Assigned
Starts but Does Not Finish
Meets Average Expectations
Resourceful and Effective
Superior Creative Ability
Leadership
*
Please select one option.
Makes No Effort to Lead
Tries but Lacks Ability
Has Some Good Leadership Promise
Leads by Example
Unusual Ability to Lead
Emotional Adjustment
*
Please select one option.
Yields to Urges or Cravings
Tense, Fearful, Worried
Easily Angered, Frustrated
Downhearted, Blue, Depressed
Maintains Balance, Self-Controlled
Teamwork
*
Please select one option.
Frequently Causes Friction
Usually Cooperative
Prefers to Work Alone
Most Effective in Teamwork
Self-Image
*
Please select one option.
Insecure
Feels Inferior
Self-Confident
May be Prone to Boasting
Modest, True Estimate of Self
PERSONAL TRAITS
Critical Spirit
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Domineering Manner
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Procrastinator
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Impractical
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Irritable
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Anxious
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Codependent
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Humble/Teachable
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Easily Discouraged
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
Takes Initiative
*
Please select one option.
Never
Rarely
Sometimes
Frequently
Unknown
Select Option
Never
Rarely
Sometimes
Frequently
Unknown
If you wish, briefly and concretely describe specific instances which support or interpret your judgments above.
Do you have any reservations concerning the personal integrity of the applicant?
*
Please Select One:
*
Please select one option.
Applicant should be accepted
Applicant
Applicant should be discouraged from pursuing this program
I recommend this applicant with reservations. Call me so I can explain.
Select Option
Applicant should be accepted
Applicant
Applicant should be discouraged from pursuing this program
I recommend this applicant with reservations. Call me so I can explain.
I acknowledge that the judgments provided on this form were submitted by the individual named above and are complete and honest to the best of my knowledge. I understand that the information that I submit will be considered confidential, and will be kept secure and private. The Kanakuk Institute certifies that this information will be shared only with Institute staff members or related ministries, including Kanakuk Kamps, KLife Headquarters, and Kids Across America.
*
Please select all that apply.
Agree
Submit
Description
Thank you for serving as a reference. We appreciate your time and input!
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