Personal Reference Form

ZION HILL BAPTIST THEOLOGICAL INSTITUTE 1900 W. Dr. Martin Luther King Jr. Way Dayton, Ohio 45417

Personal Reference Form To Be Completed by Student Applicant: I authorize the release of the following information to be considered in my application for admission to Zion Hill Baptist Theological Institute. I understand that the information will be held in confidence by the Institute, and will not be released to me or anyone else. I also understand that this questionnaire will be mailed to Zion Hill Baptist Theological Institute by the person completing the information below. Signature______________________________________________________________ Printed Name ______________________________________________________________________ Address_______________________________________________________________ City____________________________ State _________________ Zip ____________ _______________________________________________ To Be Completed by an unrelated, adult friend of the above student applicant: Please answer all questions as frankly as possible. This information will be held in strict confidence by Zion Hill Baptist Theological Institute. What is your relationship with this person? ___________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

What is this person’s marital status? ______________________________________ Do you know of any reason why this person would not be suitable to attend Zion Hill Baptist Theological Institute? ____________________________________________ If yes, please explain in the space provided. ________________________________ ____________________________________________________________________ ____________________________________________________________________ Has this person made a profession of faith accepting Jesus Christ as personal savior? ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Is this person trustworthy? ______________________________________________ List any traits or extremes: such as boldness, shyness, brilliance, dullness, etc… ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Would you want your children to be in close association with this person? Please explain ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Please use this space to make any comments about this person that you feel are relevant. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________

Mail completed form to: Director of Admissions ZION HILL BAPTIST THEOLOGICAL INSTITUTE 1900 W. DR. M. L. KING, JR. WAY DAYTON, OHIO 45417

This person’s application cannot be further processed until we hear from you.

_____________________________________________ Signature of person filling out this form

___________ Date

Printed Name: _______________________________________________________ Church Name: _______________________________________________________ Address: ___________________________________________________________ City: _______________________ State: ___________ Zip: __________________ Phone Number: (____) ____-______