Personal Reference Questionnaire

If you are human, leave this field blank.

Scholarship Applicant Name *

---

Your Name *

Email *

Phone *

---

 

How long and in what capacity have you known the applicant? *

---

What three words or phrases best describe the applicant?

(1)

(2)

(3)

---

Please rate the applicant in each of the following areas. One is the lowest rating and 5 is the highest. Additional information is optional.

Their commitment to quality work:

1

2

3

4

5

---

 

Their determination to learn and master new skills:

1

2

3

4

5

---

 

Their leadership and/or teamwork skills:

1

2

3

4

5

---

 

Their ability to problem solve and/or reach a goal:

1

2

3

4

5

---

 

Their involvement in organizations, school and/or community:

1

2

3

4

5

---

Their creativity and/or artistic skills, if known:

1

2

3

4

5

---

 

Their academic ability, if known:

1

2

3

4

5

---

 

Please write a summary of the student's capacities and strengths. What makes them deserving of this scholarship?

---

 

Signature *

Reset Signature

Signature is required.

Date *

Captcha *

reCAPTCHA is required.

Submit