Fillable 2018 Undergraduate Reference Form 2016-17_Undergraduate_Reference

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2018 Undergraduate Reference Form 2016-17_Undergraduate_Reference

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The 2018 Undergraduate Reference Form 2016-17_Undergraduate_Reference form is 3 pages long and contains:

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File type: PDF

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Please Return This Completed Form To Student in a Sealed Envelope For Submission Before 2/2/18.
• This electronic form allows you to download it to your computer, insert the requested information, save it on your computer, later modify and
save answers.
• Print a hard copy once you have completed the form. Sign using black or blue ink
• Provide the signed hard copy in a sealed envelope to the requesting student.
• Alternatively you can print the downloaded form, fill it out and submit it using additional pages as needed. We prefer, if possible, that references
be
typed.
• Do not use the backs of pages or staple pages together.
Student Information:
Your Feedback (Please limit your response to the space provided)
1. How Do You Know This Student? (Academic, personal, community).
2. What Is Your Opinion Of This Student With Respect To The Following?
A. Academic and Intellectual Potential
First Name:
Middle:
Last Name:
Current Address
City
State
Zip
Mailing Address (if different)
City
State
Zip
Home Phone Number (555) 555-5555: Mobile Phone Number (555) 555-5555:
Email Address:
Community College:
Student’s Anticipated Major at a Four Year College
© 2017 Kennedy-King Memorial College Scholarship Fund Ltd. Updated October 5, 2017
Contra Costa
Diablo Valley
Los Medanos
P.O. Box 2643 ● Martinez, CA 94553-0264 ● www.kennedyking.org
Confidential
Undergraduate - Scholarship Reference Form
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5 
Page !1 of 3
© 2017 Kennedy-King Memorial College Scholarship Fund Ltd. Updated October 5, 2017
C. Community Service & Involvement
D. Personal Attributes, e.g., Character, Integrity, Responsibility, Commitment, Determination, Hard Work,
Achievements, Hardships Overcome & Life’s Goals
Name and Title/Position of Reference (print)
Reference Signature in black or blue ink
Date (mm/dd/yyyy)
Page !2 of 3
Continued - What is your Opinion of this Student with Respect to the Following?
B. Financial Need
3. Please use this page to provide us with any further information on the student you may have pertaining to
any of the questions on the previous page or any other information you think we should consider in for the
student’s application.
© 2017 Kennedy-King Memorial College Scholarship Fund Ltd. Updated October 5, 2017
Page 3 of 3
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2018 Undergraduate Reference Form 2016-17_Undergraduate_Reference

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Completed 9 April 2020

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