Scholarship Reference – Craig Gilliam Medical Laboratory Sciences Scholarship

Student/Reference Information

Student's Name *

First Last

Student's Email *

Your Name *

First Last

Your Email Address *

Please provide the same email address that the reference e-mail was sent to.

Position/Title/Credentials *

Please let us know where you are employed and your title there.

Please provide a brief description of how you know the scholarship applicant and for about how long you have known them: *

Evaulate the Student

Please rate the student on each of the criteria listed below, with "Poor" being the lowest score and "Outstanding" being the highest. If you do not know the student well enough to properly judge them on that criteria, please choose the last option for that question. After a few additional questions, the final spot will allow you to submit any additional comments you feel are appropriate.

Written Communication *

Oral Communication *

Emotional Stability/Behavior Under Pressure *

Ability to Work with Others *

Self-confidence *

Responsibility *

Academic Study Habits *

General Appearance *

Accuracy *

Initiative *

Decision Making *

Interpersonal Skills *

Professionalism *

Attendance *

Overall Rating *

Have you ever questions the applicant's integrity? *

No
Yes

If "Yes", please explain: *

What are the applicant's strengths? *

What are the applicant's weaknesses? *

Please provide any other details that you feel may be important for the scholarship committee to consider during the selection process (Optional):

Please digitally sign this form by typing your full name in the space below. *

Please enter today's date *

Scholarship Reference – Craig Gilliam Medical Laboratory Sciences Scholarship

Student/Reference Information

Evaulate the Student

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