CARLI Scholarship Reference Form

To be completed by the person serving as a reference

Applicant name *

Your Name *

Your Institution *

Your Position *

E-mail *

Phone *

How long and in what capacity have you known the applicant? *

Please score applicant on the following criteria: *

	very good	good	average	below average	unsatisfactory	I am unable to score the applicant in this area
Oral and Written Expression *	Oral and Written Expression - very good	Oral and Written Expression - good	Oral and Written Expression - average	Oral and Written Expression - below average	Oral and Written Expression - unsatisfactory	Oral and Written Expression - I am unable to score the applicant in this area
Interpersonal Skills *	Interpersonal Skills - very good	Interpersonal Skills - good	Interpersonal Skills - average	Interpersonal Skills - below average	Interpersonal Skills - unsatisfactory	Interpersonal Skills - I am unable to score the applicant in this area
Sense of Responsibility *	Sense of Responsibility - very good	Sense of Responsibility - good	Sense of Responsibility - average	Sense of Responsibility - below average	Sense of Responsibility - unsatisfactory	Sense of Responsibility - I am unable to score the applicant in this area
Initiative *	Initiative - very good	Initiative - good	Initiative - average	Initiative - below average	Initiative - unsatisfactory	Initiative - I am unable to score the applicant in this area
Judgment *	Judgment - very good	Judgment - good	Judgment - average	Judgment - below average	Judgment - unsatisfactory	Judgment - I am unable to score the applicant in this area
Leadership *	Leadership - very good	Leadership - good	Leadership - average	Leadership - below average	Leadership - unsatisfactory	Leadership - I am unable to score the applicant in this area
Problem Solving Abilities *	Problem Solving Abilities - very good	Problem Solving Abilities - good	Problem Solving Abilities - average	Problem Solving Abilities - below average	Problem Solving Abilities - unsatisfactory	Problem Solving Abilities - I am unable to score the applicant in this area
Commitment to Service *	Commitment to Service - very good	Commitment to Service - good	Commitment to Service - average	Commitment to Service - below average	Commitment to Service - unsatisfactory	Commitment to Service - I am unable to score the applicant in this area

Additional Comments

Leave this field blank