PASTORAL REFERENCE

( From a Pastor, Church Youth Leader, or Sunday School Teacher )

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Windham Christian Academy is a college preparatory, Christian Elementary and Jr. / Sr. High School. Our mission is to develop young men and women who love God and man and who achieve academic excellence. We need your help to determine if this applicant is a good match for our school and, if admitted, how we could best serve him / her. We assure you that all information provided will remain confidential.

Please fax or mail this form directly to Windham Christian Academy. THANK YOU!

Applicant’s Name ____________________________________________________________ Date ___________________________________

1. In what capacity and for how long have you known the student and family ? _____________________________________________

2. Do all family members attend church regularly? To what extent are they involved?

__________________________________________________________________________________________________________

3. Please describe the church activities in which this student and / or family participates (Church, Choir, youth group, Bible study, Sunday school etc.)

__________________________________________________________________________________________________________

4. How often is the student and / or family involved in these activities ? Please circle one.

A. Nominally Involved

B. Regularly Involved

C. Deeply Involved

5. Please check the one which most closely assesses the student

Moral Standards ___Poor ___ Average ___ Excellent

Behavior ___Poor ___ Average ___ Excellent

Maturity ___Poor ___ Average ___ Excellent

Peer Relationship ___Poor ___ Average ___ Excellent

Relationship w/ Authority ___Poor ___ Average ___ Excellent

6. To your knowledge, has this candidate ever been involved in a violent, immoral, or abusive situation as either victim or perpetrator?

_____ Yes, Please explain _____ No, _____ Not sure, Please explain.

__________________________________________________________________________________________________________

7. Please add any further information that you think would be helpful to us. (Use back of the paper if necessary)

__________________________________________________________________________________________________________

Please answer the next 3 questions as they relate to students who are applying for grades 7-12.

8. From your observation and perception, what is the student’s personal religious experience? Please circle one.

A. The student has had a salvation experience and is growing in faith in the Lord Jesus Christ.

B. The student has had a salvation experience but has not pursued any personal growth with the Lord.

C. The student is passively interested in religion.

D. The student is disinterested in religion.

E. Other: _____________________________________________________________________________________________

9. In your observation, what qualities does this student have that would add positively to Windham Christian Academy?

___________________________________________________________________________________________________________

10. Have you ever known the applicant to smoke, drink alcohol or use drugs? _____ No, _____ Yes; If yes, please explain.

__________________________________________________________________________________________________________

Thank you for helping us to evaluate this individual. Your comments are greatly appreciated.

Name _________________________________________ Signed___________________________________________________________

Position _______________________________________ Church __________________________________________________________

Address _______________________________________________________ Phone Number ____________________________________

Should we contact you by phone for additional information?

_____ No _____ Yes