SCHOLARSHIP REFERENCE Please Circle One : Creekview, RL Turner, Newman Smith,
Ranchview, Mary Grimes
The
senior named below has given your name as a reference for his/her scholarship
application. Please furnish the
requested information and return this form to the Counseling Office.
Thanks for your assistance.
STUDENT’S NAME__________________________________________
Please rate my performance as dictated by my actions in and out of the classroom. I waive any right to see the rating sheet/reference once it has been completed unless my reference gives permission below for me to obtain a copy of this form/letter for use with additional applications.
Student’s signature_______________________________________________
NAME
OF REFERENCE:_______________________________________________________
RELATIONSHIP
TO STUDENT: TEACHER (COURSE_______) EMPLOYER OTHER
(LIST)__________
IN MAKING THE
FOLLOWING RANKINGS, PLEASE KEEP IN MIND THE RANKINGS SHOULD BE A COMPARISON OF
THIS STUDENT TO ALL OTHER STUDENTS YOU HAVE KNOWN IN YOUR CAREER.
PLEASE CHECK THE SINGE MOST APPROPRIATE BOX. NO BASIS FOR JUDGMENT INTEGRITY ACADEMIC
ABILITY LEADERSHIP DEPENDABILITY PUNCTUALITY EMOTIONAL
MATURITY WORK
ETHIC WHAT
DO YOU BELIEVE ARE THIS STUDENT’S ACADEMIC
STRENGTHS?_____________________________ _____________________________________________________________________________________________ WHAT
DO YOU BELIEVE ARE THIS STUDENT’S PERSONAL
STRENGTHS?_____________________________ _____________________________________________________________________________________________ IF
YOU HAVE KNOWLEDGE OF A SPECIAL NEED AT HOME THAT WOULD REQUIRE FINANCIAL
ASSISTANCE FOR THIS STUDENT TO ATTEND COLLEGE, PLEASE
EXPLAIN:_______________________________________________________ _____________________________________________________________________________________________ PLEASE
ATTACH A LETTER OF RECOMMENDATION TO THIS RATING FORM. ______________________________________
___________________________________________
SIGNATURE OF REFERENCE
TELEPHONE
NUMBER PLEASE
SIGN BELOW TO
INDICATE WHETHER YOU GIVE PERMISSION FOR THIS RECOMMENDATION FORM/LETTER TO BE
RELEASED TO THE STUDENT FOR USE WITH ADDITIONAL SCHOLARSHIP APPLICATIONS.
YES _______________________
NO ____________________________
TRAIT
BELOW
AVERAGE
AVERAGE
GOOD
OUTSTANDING
EXCEPTIONAL
MOTIVATION