Appalachian Scholar Reference Form
Please print or type responses
Applicant’s Name:
Name of Person Providing Reference:
How long and in what capacity have you known the applicant?
Organization:
E-mail Address:
Office Phone #:
Fax #:
Please indicate the best day and time to call if necessary:
Please respond to the following questions about the applicant:
1. How will the Appalachian Scholars Award Program impact the student’s life and goals?
2. Describe the applicant’s commitment to education, dedication, and motivation to succeed.
3. How would you describe the applicant with regards to personal characteristics such as independence,
concern for others, values, and relationships with peers?
Appalachian Scholar Reference Form Continued
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4. Please cite examples which illustrate how the applicant distinguishes him/herself from other students?
5. What is your opinion of the applicant’s ability to persist in college and complete a degree?
6. Please rate the applicant on the following criteria.
Not
Observed
Below
Average
Average
Above
Average
Exceptional
Initiative
Oral Communication Skills
Written Communication Skills
Academic Performance
Resourcefulness/Ingenuity
Ability to Interact with Others
Self-Discipline
Sense of Purpose
Leadership Ability
Civic Involvement
Motivation
Social Maturity
Reliability
Work Ethic
Ability to Relate to Other Cultures
7. What three words best describe the applicant?
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