

Three References, one from each of the following categories, must be completed and returned with your application in order to be considered for this scholarship:
Applicant Name Phone
Applicant: In what capacity have you known the person completing this form?
The student listed above is applying for a $1000 scholarship from the
1. 2. 3. 4. 5.
Please compare the candidate in relation to others you’ve known in the same age group by checking the appropriate box for each characteristic listed below.
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Characteristic |
Outstanding |
Very Good |
Average |
Below Average |
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Artistic potential |
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Artistic achievement |
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Work/practice habits |
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Initiative |
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Creativity |
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Common Sense |
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Seriousness of purpose |
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Reaction to criticism |
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Self discipline |
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Peer compatibility |
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Conduct |
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Integrity |
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Additional written comments on the back of this form are encouraged and will help us make a more informed decision regarding this applicant.
Printed Name Signature Phone Date
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