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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: (____) ____-______