Student Reference Online Form

Applicant’s Name: *

The above named person has applied for admission to Weimar Academy and has given your name as a reference. Please be honest and candid in your evaluation. This referral will be kept strictly confidential. Since this form must be on file before his/her admission can be considered, please return it promptly.

Weimar Academy, PO Box 486, Weimar, CA 95736; Fax 530-422-7910; academy@weimar.org

How long have you known the applicant? *

In what capacity? *

What do you believe are the applicant’s greatest strengths? *

In what ways might the applicant need to experience positive growth? *

Do you have any information about the applicant’s life or background which you believe might be of particular concern to Weimar Academy? If so, please explain: *

Additional comments? (optional)

Please select the number which best describes the applicant in each of the areas of growth listed below.

Note: 5 indicates the applicant is most like the characteristics on the left side, and 1 the characters on the right side. If you feel you cannot honestly evaluate a certain characteristic, please select the N/A.

SOCIABILITY

Shy, Introverted, Unsocial

SPIRITUALITY

Immature, Shaking, Stagnating

JUDGMENT

Rash, Impulsive, Headstrong

SERVICE ATTITUDE

Indifferent, Self-centered

INDUSTRIOUSNESS

Lazy, Incomplete, Needs supervision

CHOICE OF FRIENDS

No standards, Careless

HEALTHY LIFESTYLE

Uninformed, careless, Seems sickly

INFLUENCE ON OTHERS

Passive detrimental

TRUSTWORTHINESS

Needs guidance, Irresponsible

INTELLECT

can’t make ends meet, high risk

FINANCES

Slow, Unmotivated, self-satisfied

EMOTIONAL STABILITY

Dependent, Weak, Troubled

ATTITUDE TO AUTHORITY

Rebellious, Querulous, Resentful

Considering the applicant for acceptance as a student at Weimar Academy: *

I recommended without reservation

I recommended with some reservation

I do not recommended under present circumstances

I do not recommended under any circumstances

Your Name *

Position/Title *

Date *

Address

City *

State *

Zip Code *

Country *

Phone *

Email *

Student Reference Online Form