Reference Form

To The Person Completing This Recommendation: (Non-family members)

The person below is applying for admission to the Houghton College P.A.C.E. Program. P.A.C.E. enables adults to complete a Bachelor of Science in Management in about 16 months by taking just one course at a time and attending class one night a week. Would you please evaluate the applicant’s academic, work and/or personal potential by completing this form and returning it to the P.A.C.E. Office at the above address. Please do not delay as we must receive this evaluation before the applicant can be admitted. We thank you for your time.

P.A.C.E. Applicant’s Name (Last, First)

How well do you know the applicant (circle one)? Very Well Well Casually

How long have you known the applicant?

In what capacity have you known the applicant?

Would you recommend the applicant for admission to this program (circle one)?

Highly recommended Recommended Recommended with reservation Not recommended

Please rate the applicant in the following areas by checking the appropriate box below.

Above Below No Basis For

Exceptional Average Average Average Unsatisfactory Judgment

Desire to Learn r r r r r r

Personal initiative r r r r r r

Self-confidence r r r r r r

Ability to speak clearly r r r r r r

Ability to learn independently r r r r r r

Ability to manage time r r r r r r

Ability to work in a group r r r r r r

Ability to write clearly r r r r r r

Please use the back of this page to comment on the recommendation you have made or to add any other information you believe would give insight as we consider this person for admission to Houghton College.

Name (print) ________________________________________ Day Phone

Organization/Company (for professional references)

Address

City, State, Zip

Your Signature ________________________________________ Date  ______________________

Houghton College P.A.C.E. 810 Union Road West Seneca, NY 14224 716-674-6363 or 1-888-874-PACE(7223)