Applicant Name:
The person named above has applied to be a student at the Kanakuk Institute.  We rely on people like you to help us accurately appraise our prospective students.  This includes identifying positive or negative situations from the past or present conditions, which affect the applicant's ministry effectiveness or suitability for admission to the Kanakuk Institute.
Your Name:
Relationship to Applicant:
Address
City, State, ZIP	AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Work Phone:
Home or Cell Phone:
Please rate the candidate by placing a check mark by one or more items under each of the headings below. Do not check items of which you feel uncertain or in which you have had no opportunity to observe.     Sociability or friendliness Responsiveness Avoided by Others Tolerated by Others Liked by Others Well-Liked by Others Sought by Others Slow to sense how others feel Reasonably responsive Understanding and thoughtful Response with unusual insight and consideration     Intelligence Emotional Adjustment Learns and thinks slowly Average mental ability Alert; has a good mind Brilliant; exceptional capacity Yields to urges or cravings Tense, fearful, worried Easily angered, frustrated Downhearted, blue, depressed Maintains balance, self-control     Achievement Teachability Does only what is assigned Starts but does not finish Meets average expectations Resourceful and effective Superior Creative Ability Rigid, Argumentative Highly opinionated Open-minded Willing to receive instruction Eager to receive instruction     Leadership Self-Image Makes no effort to lead Tries but lacks ability Has some leadership promise Good leadership ability Unusual ability to lead Insecure Feels inferior Self-confident May be prone to boast Modest, true estimate of self Teamwork Handling Conflict Frequently causes friction Usually cooperative Prefers to work alone Most effective in teamwork Effectively works it out Stuffs frustration Explosive, angry outburst Seems passive-aggressive     Have you noticed in the applicant? Critical Spirit Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Argumentative Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Domineering Manner Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Procrastinator Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Impractical Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Irritable Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Easily discouraged Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Anxious Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Moody Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Tendency toward dependent relationships Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Homosexual relationships Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Punctual Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Humble / teachable Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Adaptable Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Dependable Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Mature Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Ability to communicate Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent Takes initiative Select One Not Known Very Apparent Frequently Sometimes Rarely Never Apparent     If you wish, describe briefly and concretely specific instances which support or interpret your judgments above.      How long have you known the applicant?     Do you have any reservations concerning the personal integrity of the applicant? YesNoDon't Know     Please select one:   Applicant should be accepted Applicant should not be accepted Applicant should be discouraged from pursuing this program. I recommend this applicant with reservation. Call me so I can explain.   Would you like to add any additional insight?YesNo   By checking this box, I acknowledge that the judgments provided on this form were submitted by the individual named above and are complete and honest to the best of my knowledge. I understand that the information that I submit will be considered confidential, and will be kept secure and private. The Kanakuk Institute certifies that this information will be shared only with Institute staff members or related ministries, including Kanakuk Kamps, K-Life National, Kids Across America, and John Brown University.