CBC Reference Form
Thank you for responding to this questionnaire. Your responses will be carefully evaluated and taken into account when deciding on the applicant's qualifications for the scholarship award.
Date of Reference *
Your answer
Name of Student *
Your answer
Name and Title of Referrer *
Your answer
How do you know the student? *
The student exhibits enthusiasm for his/her faith development *
Poor
Excellent
The student strives for excellence in his/her academic pursuits *
Poor
Excellent
The student strives for excellence in his/her non-academic pursuits *
Poor
Excellent
The student exhibits the kind of leadership ability I could one day follow *
Poor
Excellent
The student's attitude toward receiving instruction or constructive criticism is *
Poor
Excellent
The student's attitude toward authority and authority figures is *
Poor
Excellent
The student exhibits hospitality toward others *
Poor
Excellent
The student can be counted on to follow through on assigned projects *
Poor
Excellent
The student can be counted on to show up to important events, school and church *
Poor
Excellent
The student is punctual to school, events, church, assigned projects *
Poor
Excellent
The student seeks opportunities to serve *
Poor
Excellent
I would judge the student's overall character as *
Poor
Excellent
Please feel free to expand on any of the above responses in the space below:
Your answer
In your own words, why would you award an academic and performance scholarship to this student? *
Your answer
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