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Reference Form
Urban Scholars Program Application—Reference Form
Applicant's Name:
Name of Person Providing Reference:
How long and in what capacity have you known the applicant? :
Organization:
Email Address:
Office Phone #:
Fax #:
Please indicate the best day and time to call if necessary:
Question 1:
How will the Urban Scholars Award Program impact the student's life and goals?
Question 2:
Describe the applicant’s commitment to education, dedication, and motivation to succeed.
Question 3:
How would you describe the applicant with regards to personal characteristics such as independence, concern for others, values, and relationships with peers?
Question 4:
Please cite examples which illustrate how the applicant distinguishes him/herself from other students?
Question 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.
Initiative:
Not Observed
Below Average
Average
Above Average
Exceptional
Oral Communications Skills:
Not Observed
Below Average
Average
Above Average
Exceptional
Written Communications Skills:
Not Observed
Below Average
Average
Above Average
Exceptional
Academic Performance:
Not Observed
Below Average
Average
Above Average
Exceptional
Resourcefulness/Ingenuity:
Not Observed
Below Average
Average
Above Average
Exceptional
Ability to Interact with Others:
Not Observed
Below Average
Average
Above Average
Exceptional
Self-Discipline:
Not Observed
Below Average
Average
Above Average
Exceptional
Sense of Purpose:
Not Observed
Below Average
Average
Above Average
Exceptional
Leadership Ability:
Not Observed
Below Average
Average
Above Average
Exceptional
Civil Involvement:
Not Observed
Below Average
Average
Above Average
Exceptional
Motivation:
Not Observed
Below Average
Average
Above Average
Exceptional
Social Maturity:
Not Observed
Below Average
Average
Above Average
Exceptional
Reliability:
Not Observed
Below Average
Average
Above Average
Exceptional
Work Ethic:
Not Observed
Below Average
Average
Above Average
Exceptional
Ability to Relate to Other Cultures:
Not Observed
Below Average
Average
Above Average
Exceptional
7. What three words best describe the applican:
