Master’s/BA/Certificate Reference

Master’s/BA/Certificate Reference

To Be Completed By The Reference:

If you have been invited to provide a reference for a student seeking to enroll in a program through Kairos, please complete the online reference form below. This is an important step because it gives you a chance to share with us what God is doing in and through the life of this student.  If you have questions, feel free to email us at

Please note that: 1) The student who asked you to write the reference has a legal right to read what you have written. I f that concerns you, feel free to talk with the student who asked you to provide a reference and 2) All reference forms completed online are subject to verification by the Office of Enrollment Management.

* Name of Applicant

* Name of person giving reference

* Person giving reference is:
personal reference

* Please indicate the nature of your association or contacts with the applicant, including frequency and duration of contacts, which serve as the basis for your impressions of him or her as a prospective student.

Check all that apply:

Responsiveness to others
 Reasonably responsive  Shows exceptional insight and consideration
 Understanding and thoughtful  Slow to sense how others feel

Initiative / Perspective
 Resourceful and effective  Does only what is assigned
 Superior creative ability  Meets average expectations

 Rigid, argumentative  Open-minded
 Highly opinionated  Eager to receive instruction

 Has some leadership promise  Has exceptional ability to lead
 Has good leadership ability  Makes no effort to lead

 Usually cooperative  Frequently causes friction
 Most effective in teamwork  Prefers to work alone

Financial Responsibility
 Shows mature responsibility  Expects others to meet needs
 Talks frequently of debt or financial worries  Careless, extravagant

Personality Traits (Check those that apply)


Integrity / Spiritual Maturity - Does the person:

* Appraise strengths and weaknesses objectively and accurately? Yes No
Not Observed

* Represent himself or herself honestly? Yes No
Not Observed

* Pursue goals ethically and conscientiously? Yes No
Not Observed

* Demonstrate appropriate spiritual maturity? Yes No
Not Observed

* Involve himself or herself in the life of the church? Yes No
Not Observed

Moral Character - To your knowledge has this person:

* Ever been charged with or convicted of a crime? Yes No
Not Observed

* Ever been engaged in or been the subject of a charge of unethical or immoral conduct or behavior? Yes No
Not Observed

* Ever engaged in or been the subject of a charge of sexual misconduct? Yes No
Not Observed

Please Provide all relevant information explaining your answer if you answered "yes" to any part of the Moral Character section

Does this person have any complicating factors in his or her life that might hinder the applicant's success as a student or as a Christian professional?

* Do you see this person as someone you would like to have as your pastor, church staff member, therapist, or colleague?
 Yes  No  Unsure

* I recommend this applicant for admission to the Kairos Project.
 Highly recommend
 Recommend with reservations
 Do Not Recommend

* Position

* Address

* City* State/Province*Zip/Postal Code

* Country

* Phone
* Email

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