Burruss Scholarship Reference Form

For the confidential evaluation of a scholarship applicant by a teacher, academic advisor, employer, or organizational associate

If you have been invited to submit a confidential evaluation of an individual applying for a Burruss Educational Scholarship from Shiloh Baptist Church (Old Site), please fill out the form below. Then click “Submit” at the bottom of the form.

All application materials, including evaluations from references, are due by May 15.

The evaluation you provide will go directly to members of the scholarship committee. It will not be shared with the applicant.

On-line Burruss Scholarship reference form

Name of the scholarship applicant (the person for whom you are supplying a reference) *

First

Last

Your own name *

First

Last

School, business, or organization with which you are affiliated *

Your job title or role at this school, business, or organization *

How long and how well have you known the applicant? *

In what capacity have you known the applicant? *

How reliable and trustworthy have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

How eager to learn have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

How willing to accept criticism have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

How respectful, courteous, and helpful to others have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

How positive in attitude have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

How goal oriented have you found the applicant? (Use the slider. 0 is low and 10 is high.)

Selected Value: 0

Describe your impression or experience of the applicant's character *

Describe your impression or experience of the applicant's academic potential *

Describe Your impression or experience of the applicant's educational or work dedication *

Best phone number for you *

Enter a phone number in case we have questions.

This phone number is for a… *

Home phone
Mobile phone
Work phone

Best email address for you *

Enter an email address we can use if we have questions.

On-line Burruss Scholarship reference form

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