Higher Education Scholarship Reference Form
Administered by First United Presbyterian Church
Applicant's Name
*
First Name
Last Name
Person Completing This Reference
*
First Name
Last Name
My relationship to the applicant is:
*
Pastor
Youth Leader
Sunday School Teacher
Clerk of Session
Current Session Member
Committee Chair that Applicant serves on
Reference Person Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reference Person Email
*
example@example.com
Today's Date
-
Month
-
Day
Year
Date
I have verified that the applicant is a church member of
*
Please Select
Belle Center United Presbyterian Church
First United Presbyterian Church Bellefontaine
Huntsville Presbyterian Church
How long have you known the applicant?
Are you a relative of the applicant (if yes, you are not able to provide a reference)
*
Please Select
Yes
No
Please use a rating scale of 5 = outstanding; and 1 is below average
Character / Respect for Others
*
Please Select
5
4
3
2
1
Do Not Know
Demonstrated Leadership
*
Please Select
5
4
3
2
1
Do Not Know
Motivation and Seriousness of Purpose
*
Please Select
5
4
3
2
1
Do Not Know
Demonstrated Service to Others
*
Please Select
5
4
3
2
1
Do Not Know
Commitment to school/academic ability
*
Please Select
5
4
3
2
1
Do Not Know
Oral & Written Communication Skills
*
Please Select
5
4
3
2
1
Do Not Know
Independence/maturity/Initiative
*
Please Select
5
4
3
2
1
Do Not Know
Church Involvement (when living in Logan County):
Sunday School
*
Please Select
5
4
3
2
1
Do Not Know
Fellowship (youth or adult)
*
Please Select
5
4
3
2
1
Do Not Know
Worship
*
Please Select
5
4
3
2
1
Do Not Know
Other (Mission, Choir, Committees etc)
*
Please Select
5
4
3
2
1
Do Not Know
If away at school, their attendance when home for breaks, or during the summer?
*
Please Select
5
4
3
2
1
Do Not Know
Comments:
If currently living out-of-county, is the applicant involved in any church/faith-based organizations?
*
Any additional information you feel would be helpful for the 1st UPC Scholarship Committee to know?
Please submit this reference BEFORE 4:00 pm, April 15 (earlier is encouraged!) The applicant's application is not complete without this reference
Submit
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