Academic Reference Form - George Fox University

Academic Reference Form
This form is to be filled out by an individual who can attest to your academic work. It should not be completed
by a member of your immediate family.
Directions for Applicant:
1. Use Adobe Acrobat Reader 9.0 or higher. A free version is available for download at www.adobe.com/reader.
2. Type in your name in the “Applicant’s Name” field, select your program, field and save a copy on your computer.
3. Attach the form in an email and send directly to your reference provider(s).
Applicant’s name __________________________________________________________
Applicant is applying for:
LOCAL LEARNING COMMUNITY (Portland Campus)
Master of Divinity
Master of Arts, Ministry Leadership
Master of Arts, Spiritual Formation
Master of Arts, Theological Studies
Certificate in Spiritual Formation and Discipleship
ONLINE LEARNING COMMUNITY
Master of Divinity
Master of Arts, Ministry Leadership
Master of Arts, Spiritual Formation
D.Min, Leadership and Global Perspectives
D.Min, Leadership and Spiritual Formation
D.Min, Semiotics and Future Studies
Under the Family Educational Rights and Privacy Act of 1974 (Buckley Amendment), which gives students the right to
inspect and review their educational records, students may waive their right to see specific confidential letters or
recommendations.
☒ By using this form, the applicant named above waives their right to examine this form at a
future date.
If the applicant does not wish to waive this right, another form may be requested from the admissions counselor.
Directions for the Reference Provider:
1. Use Adobe Acrobat Reader 9.0 or higher. A free version is available for download at www.adobe.com/reader.
2. Type your responses to each question, and save a copy on your computer. You may also print the form and write in
your responses.
3. Attach the form in an email to seminary@georgefox.edu. You may also fax it to 503-554-6111, or send to the
address below.
1. How long have you known the applicant? How well? In what capacity?
2. What evidence have you observed of the applicant’s concern for others?
3. Do you believe this individual is well suited for pursuit of his/her personal academic or ministry leadership goals through
graduate training? Why or why not?

4. To what extent have you observed the applicant engaged in his/her ministry/academic setting? Please describe.
5. What are the applicant’s greatest strengths and what are the applicant’s areas for growth and improvement?
6. Evaluate the applicant’s initiative and time management skills.
7. Has the applicant demonstrated skill in interpersonal communication? What is this person’s influence on others?
8. Does the applicant demonstrate the scholarly/academic aptitude necessary for success in graduate-level training?
9. Does the applicant have a support network that will encourage him/her throughout his/her program of study?
In consideration of the applicant’s suitability for study and overall potential for success in an academic
program, please check one of the following:
I highly recommend I recommend I recommend with reservation I do not recommend
_________________________________________________________________________________________
NAME
______________________________________________________
EMAIL
______________________________________________________
ADDRESS
________________________________
DATE
________________________________
DAYTIME TELEPHONE
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POSITION
ORGANIZATION
May we call you about this applicant? Yes No
Please return this form by email to seminary@georgefox.edu, fax to 503-554-6111, or send in a sealed
envelope with your signature over the flap and mail directly to George Fox University. Thank you for
your assistance.
Office of Graduate Admissions
George Fox Evangelical Seminary
12753 SW 68th Ave.
Portland, OR 97223