Scholastic Reference

Scholastic Reference Form

Provided by The Oregon District Youth Committee
To High School Principal/Teacher or College Official: The student who has given you this reference form is applying for the Sadie and Samuel Hart Bible/Christian College scholarship provided by Oregon Youth Ministries. Your prompt reply is deeply appreciated and will be held in strictest confidence. Your observations above and beyond the questions are extremely helpful.
Your Name*

First NameLast Name
PrincipalTeacherProfessorOther
School/College Name
Address*

Street Address

Apt/Suite #

CityState

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Scholarship Applicant's Name*

First NameLast Name

Your reference on this individual is very important since you have the opportunity to interact with him/her frequently. Please evaluate the applicant in the following areas:*

Rows	Top 10%	Above Average	Average	Below Average	Inadequate Opportunity to Observe
Emotional stability
Personal appearance
Moral character
Personal initiative
Cooperativeness
Respect for authority
Personal motivation
Leadership ability
Personal development
Consideration for others
Personal responsibility
Academic achievement
Classroom participation

How long have you known this individual?*
Do you know if any health factors (physical or emotional) of which we should be aware?*
If so, please explain:
Would you, without reservation, recommend this applicant for a scholarship?*
If not, please explain:
Do you have any additional comments on this application?
Should be Empty:

Scholastic Reference Form