Application for the Lilly Endowment Community Scholarship of Wabash County

2017/2018Lilly ApplicationRequirement 8:Recommendation of a Teacher or Other Adult

To be completed by an employer, advisor, supervisor, coach, teacher, or other professional who is not a relative, with whom you have a working relationship.

Directions to the Student:Print your full name and the initials of your school on the first line. Print the name of your reference and the reference’s email address on the second line. Be sure to ask for a recommendation from a teacher or other adult who knows your talents and qualifications. Allow them enough time to provide a thoughtful response (at least one to two weeks). Send an email message to your reference with this form attached.
Student’s Full Legal Name Secondary School Initials
Reference’s full name Reference’s email address
Family Educational Rights and Privacy Act of 1974
Under the provision of the Family Educational Rights and Privacy Act of 1974, you have the right to review your educational records. The Act further provides that you may waive your right to see letters of recommendation written on your behalf. By signing below, you agree you will not seek access to the confidential recommendation submitted on your behalf for the sole purpose of your application for Scholarships from the Community Foundation of Wabash County.
Student Signature Date
1

Directions to Reference: You have been chosen by this applicant to submit one of the required recommendations for a scholarship(s) awarded by the Community Foundation of Wabash County. We are grateful for your help and cooperation. We suggest that you retain a copy for your files. Please complete this form and write additional comments, save them on your computer and attach themto an email to by September 25, 2017.

How long have you known the applicant? / How well do you know the applicant?
What is your relationship to the applicant?

QualitiesExcellentAbove AverageAverageBelow AverageUnacceptableCannot

Evaluate

Initiative in academics

Leadership

Disciplined work habits

Communication skills

Emotional maturity

Character and personal

promise

Concern for others

Overall

Letter of Recommendation: The Selection Committee that will review this recommendation would appreciate receiving additional comments regarding this student’s strengths, potential difficulties, or unusual circumstances or experiences. Your written recommendation will be very useful. Please attach additional comments on a separate page.

Signature of teacher or adult / Title or position

Printed name of teacher or adult