Personal Reference Questionnaire

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Scholarship Applicant Name *

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Your Name *

Email *

Phone *

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

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What three words or phrases best describe the applicant?

(1)

(2)

(3)

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Please rate each of the following areas 1-5, with 1 being the lowest and 5 being the highest. Add additional information as needed.

Their commitment to quality work:

1

2

3

4

5

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Their determination to learn and master new skills:

1

2

3

4

5

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Their leadership and/or teamwork skills:

1

2

3

4

5

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

1

2

3

4

5

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Their involvement in organizations, school and/or community:

1

2

3

4

5

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Their creativity and/or artistic skills, if known:

1

2

3

4

5

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Their academic ability, if known:

1

2

3

4

5

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

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