SCHOLARSHIP APPLICANT:

You are responsible for securing the following Scholarship Reference Form from the 5 references that you listed on the application form. You will need to add their name as the Reference Name and then your name as the Applicant. You can either collect the references and return with your application or they can mail the references directly to the address below. As with the transcripts, the references are confidential and need to be returned in a sealed envelope. Unsealed references will not be considered.

Remember – references should not be a member of the applicant’s family.

Melissa Green, Program and Teen Mentor Specialist – Area 2

Girl Scouts of Central Texas

3700 W. Waco Drive

Waco, Texas 76710

GIRL SCOUTS OF CENTRAL TEXAS
SCHOLARSHIP REFERENCE FORM /

Reference Name:______

______has applied for a scholarship to be awarded by the Girl Scouts of Central Texas and has listed you as a reference. Recipients must be active participants in Girl Scouting, must have demonstrated good academic progress and be serious about their education. Please take a few minutes to rate this applicant on each of the items below and to answer the other questions; then return this form in a sealed envelope to the applicant or directly to me at the following address by Monday, February 6, 2017:

Girl Scouts of Central Texas

ATTN: Melissa Green

3700 W. Waco Drive

Waco, TX 76710

Thank you for taking time to assist us in the selection process. Please feel free to telephone me at 254-756-4497, ext. 610 if you have questions or would like to add further information.

Sincerely,

Melissa Green, Program & Teen Mentor Specialist – Area 2

Girl Scouts of Central Texas

Please rate the applicant on
each item by checking the appropriate box to the right. / OUTSTANDING / ABOVE
AVERAGE / AVERAGE / BELOW
AVERAGE / UNACCEPTABLE
1. Responsibility
2. Participation in School or Girl Scout activities
3. Dependability
4. Leadership
5. Cooperation with Adults
6. Academic Ability
7. Academic Achievement
8. Perseverance
9. Overall Prospects for Success in Future Education

Continued on Back . . . Updated 10/13/16

How long have you known this applicant? In what capacity?

How do you believe this applicant might contribute to society if given the chance for further education?

Would you recommend that this applicant receive a scholarship? Why or why not?

GSCTX/SCHOLAR/REFFORM/9-2016