Christian Character Reference Template
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1STEP 2
SAGU
Undergraduate Application for Admissions
Christian Character Reference
Applicant Instructions and Information
Anticipated Enrollment:
Fall
Spring
Summer
Year
Please complete this section and sign the statement below if you wish to waive your rights as stated. Your pastor, former pastor, youth pastor, or church lay-leader
(elder, deacon, or board member) should complete the Recommendation section. (The individual may not be a relative.)
Student’s Last Name
Student’s First Name
Middle Name
Student’s Current Address
City/State/Zip
According to PL 39-380, the Family rights and Privacy Act of 1974, the information contained in this reference questionnaire must be shared with the student upon request.
However, the applicant may, at his/her discretion, voluntarily waive the right of access to the information by signing the following statement.
Waiver of Rights: I hereby waive my right of access to all information contained in this reference questionnaire with the understanding that it will be used only for the
purpose of evaluating my application for admission to Southwestern.
Signature
Date
(use last 4 digits of SSN if electronic)
Recommendation
The person named above on this reference form has applied for admission to Southwestern Assemblies of God University and has given your name as a reference.
Please complete the following reference form to the best of your knowledge and return to: SAGU, Admissions Office, 1200 Sycamore, Waxahachie, Texas, 75165.
How long have you known the applicant?
To what extent have you known the applicant?
Personal relationship
Somewhat closely
Indirectly
Distantly
To your knowledge, in the past 3 years has he/she: Used drugs illegally?
Yes
No
Used tobacco?
Yes
No
Used alcohol?
Yes
No
Struggled with pornography?
Yes
No
Struggled with sexual promiscuity?
Yes
No
Struggled with homosexuality?
Yes
No
To your knowledge, has the applicant ever been divorced?
Yes
No
Remarried?
Yes
No
Do you know of anything, which might hinder the applicant from making satisfactory progress as a student? (If so, please comment on separate page.)
Please check the following:
Excellent
Good
Fair
Poor
Not Known
Moral character
Emotional stability
Leadership
Influence on others
Concern for others
Attitude toward authority
Church involvement
Readiness for college
(If you check fair or below on any of these, please give additional explanation on separate page.)
For admission to Southwestern Assemblies of God University, this student is recommended:
With enthusiasm
Strongly
With Reservation
Not Recommended
Please Print Your Name:
Signature
Position
Date
(use last 4 digits of SSN if electronic)
Church
Denomination
Phone
Address
City/State/Zip
Thank you for your assistance. This completed and signed application can be submitted via:
Mail: Southwestern Assemblies of God University, Admissions Office, 1200 Sycamore Street, Waxahachie, TX 75165
Fax: 972-923-8133 Email: Admissions@sagu.edu
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