GSDSW Scholarship Reference Form

Thank you for supporting *

She has selectd you as an adult familiar with her character and accomplishments to complete this Scholarship Reference Form.

Please complete this form by Friday, April 19, 2024.

Reference First Name *

Reference Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Position in Girl Scouting (if applicable)

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

Based on your knowledge of the applicant, please rate the following qualities

A = Excellent

B = Average

C = Poor

D - Don't Know

Please enter A, B, C, or D *

	Rating
Is dependable and responsible	Rating
Accepts differences in people	Rating
Relates well to peers	Rating
Is adaptable and flexible	Rating
Has sound values and integrity	Rating
Has poise and ease meeting people	Rating
Is able to share ideas and opinions	Rating
Relates well to adults	Rating
Demonstrates positive leadership qualities	Rating

In your experience with the applicant, what skills, interests and aptitudes have been demonstrated which you think would make her especially qualified for this scholarship. *

Has the applicant served her community? *

What else would you like for the scholarship committee to take into consideration regarding this applicant? *

Signature *

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Date * +