Print your name and address in the space below. Check (in the appropriate box) whether you have or
have not waived the right to review the information contained in your admissions file and give this
form to your academic reference. Relatives are not permitted to complete reference questionnaires.
( ) -
Applicant’s Last Name First Name M.I. Home Telephone Number
Mailing Address City State Zip Code
E-mail address
I ❑ have / ❑ have not waived the right to review my admissions file.
If you are a non-traditional student (23 or older), please use this form as an Employer
Reference, to be completed by your supervisor at work. The Employer Reference you
choose ONLY needs to fill out the back side of this form, not the information below!*
*If you are an Employer Reference, please skip to the next section.
Each applicant for admission to Cincinnati Bible College must submit an academic reference
questionnaire. We value your comments and request that you give a full and candid report, so that fair
consideration may be given to the applicant.
1. How long have you know the applicant?
2. In what academic setting have you known the applicant?
3. How well do you know the applicant? (Check where appropriate)
❑ By name/sight ❑ Very well/numerous personal contacts
❑ Casually/few personal contacts ❑ Know the student quite well
4. Are the parents of this applicant: ❑ Supportive of academics ❑ Unsupportive of academics
5. Briefly describe why you believe this student will succeed in completing a college degree.
6. How would you describe the applicant’s approach to his/her academics?
7. Describe the applicant’s strengths and weaknesses.
8. How would you describe the writing skills of the applicant:
❑ stream of consciousness ❑ well-constructed, supported, organized
❑ thoughtful, but lacks organization ❑ Other comments:
Academic Reference Questionnaire
To Be Completed by the Applicant
To Be Completed by the Academic Reference
➩
To Be Completed By the Employer Reference
*Please Skip to the next section if you are an Academic Reference.
1. How long has the applicant been employed in their present position?
2. Is the applicant punctual?
3. Does the applicant work within the guidelines of the company?
4. Please describe the applicant’s attitude toward their work.
5. Please describe the applicant’s outstanding abilities or talents.
6. How well does the applicant follow instructions?
7. Would you describe the applicant as a self-starter or one who needs to be motivated by others?
*Must be completed by Academic or Employer Reference.
Would you recommend that we accept this applicant? ❑ Yes ❑ No ❑ Don’t Know
Name (Please print) Relationship to Applicant
( ) - ( ) -
Home Telephone Number Work Telephone Number E-mail
Street Address City State Zip Code
Signature Date
Thank you for taking the time to complete this questionnaire. Your observations will assist us in our
evaluation of the applicant. Please return this questionnaire at your earliest convenience to:
Cincinnati Bible College Or, fax to: 513 - 244 - 8453
Attn: Admissions Attn: College Admissions
2700 Glenway Avenue
Cincinnati, OH 45204
Thank-you
To be Completed by Academic/Employer Reference
