ESLAC Scholarship Reference / Recommendation Form

Name of Applicant

First NameLast Name

Please select the scholarship this application is for

Applicant Instruction: This form is to be provided to a teacher(s), minister, youth leader, community service leader or employer who knows you well and who can speak to the attributes listed below on your behalf in consideration for this award. Relatives cannot serve as recommenders.

Recommender Instruction: Thank you for your assistance and for your willingness to recommend the applicant listed above as we evaluate her for educational financial assistance. Please attest to the following which will assist us in our selection process based on your experience and knowledge of the applicant.

Please rate the applicant on the following characteristics, according to the scale listed from 1-5, 5 being the highest ranking. If you are unable to speak to a characteristic or skill, please note by selecting n/a.

Demonstrated willingness to work toward future goals

Demonstrated sense of responsibility

Enthusiasm for achieving success

Honesty and integrity

Ability to get along with others

Emotional maturity

Leadership skills

Contributions to school

Contributions to community

Ability to succeed in chosen field

Responsibility and care in completing academic tasks

Written and oral communication skills

Please print any additional comments in support of the applicant here:

How long have you known the applicant?

In what capacity?

Position

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Recommender Name

First NameLast Name

Recommender Signature

Date