City Leadership School Reference Form (Parent/Guardian) (for students that live with parents or guardian only) Name of Applicant * Please include middle name with first name, if applicable. First Name Last Name Instructions The person named above is applying for admission to Portland Bible College. Because the college is a church related school and desires to support the authority of parents in young single student's lives, we desire your cooperation in completing this form. All information will be held in strict confidence. Your reference, along with other required references, will help us in our decision as to whether to accept this student's application or not. Family Data Mr. First Name Last Name Mrs. First Name Last Name What relationship does the applicant have to you? * Son Daughter Other If other, please explain relationship: Has the Applicant discussed or counseled with you concerning his/her interest in attending City Leadership School? * Yes No Has the applicant had any serious problems in submitting to parental or other authority? * Yes No Please comment: What do you understand to be the real motive for the applicant wanting to attend City Leadership School? * Religious Information Church presently attending * Pastor's Name First Name Last Name Phone (###) ### #### Church Address Address 1 Address 2 City State/Province Zip/Postal Code Country Approval Do you fully approve of the applicant attending City Leadership School? * Yes No Please feel free to add further comments: Parent/Guardian Signature * I understand that by typing my name, I am digitally signing this document. First Name Last Name Date * MM DD YYYY Thanks for submitting this form! Your information has been received, and we’ll be in touch, soon. In the meantime, feel free to browse our site and get to know more about our church.
