Personal Reference Form

The following form should be filled out, as thoroughly as you are able, by a personal reference for the student applying to Act Five. You have been selected by the applicant as someone who can speak to his/her character, faith, relationships and various experiences. Thank you for giving of your time in this capacity.

  • Applicant Information

  • Reference Information

  • Reference Questions

  • Please complete the following, to the best of your ability:

  • On a scale of 1-5 (5 being the most positive), indicate the applicant's level of maturity * Required
  • On a scale of 1-5, indicate the applicant's ability to handle conflict with peers * Required
  • On a scale of 1-5, indicate the applicant's willingness to take on new challenges * Required
  • On a scale of 1-5, indicate the applicant's level of self-awareness * Required
  • Final Questions

  • Do you recommend that we accept this applicant? * Required
  • Signature

  • Date Format: MM slash DD slash YYYY