Letter of Recommendation for a Worcester Chapter AGO Scholarship Award

To the Applicant:
This recommendation will not be disclosed to any unauthorized individual without your consent.
You will be accorded access to its contents unless you voluntarily waive your right of access.
Please check one of the following options below and fill in your name, signature, and the date.

I have read the information above and hereby
_____waive
_____do not waive

my right of access to this document.

Name of Applicant___________________________________________________________

Signature_________________________________Date_____________________________

To the Recommender:
Your willingness to provide information about the applicant named above, who is applying for a Worcester Chapter AGO Scholarship Award is greatly appreciated. The applicant will have access to this recommendation unless he/she has waived that right.

Please return this form to:
The Worcester Chapter AGO
P.O. Box 20208
Worcester, MA 01602

All materials must be postmarked no later than March 31st for an application to be considered.

Name of Recommender______________________________________________________

Address__________________________________________________________________

Telephone_______________________E-mail address______________________________

1) How long and under what circumstances have you known the applicant?

2) Please evaluate the applicant using the following chart. If you are unable to judge, please indicate.

Initiative
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Motivation
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Perseverance
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Maturity
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Interpersonal skills
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Communication skills
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

Potential for growth
Below Average___; Average___; Good___; Excellent___; Exceptional___; Unable to judge___

3) Please include any additional observations or comments that will assist the Scholarship Committee in its deliberations.

4) Summary evaluation
_____I do not recommend this applicant receive a scholarship.
_____I recommend this applicant receive a scholarship.
_____I strongly recommend this applicant receive a scholarship.

Signature____________________________________Date__________________________