Reference Form | Crossroads Officials Association

Reference Full Name:

Address:

Email:

Phone:

Employer:

Position:

Reference Applicant Full Name:

The above-named has applied for a scholarship from Crossroads Officials Association and has listed your name as a reference. We would appreciate your candid estimate of the applicant and shall keep this information confidential. Please select along the scale where you feel the applicant is best described and then answer the short answer questions that follow. If you feel you have inadequate information to form a fair judgment on a particular quality, please leave it blank.

Personal Maturity - Evaluate applicant’s emotional and interpersonal maturity

Immature

Average

Growing

Unusual Insight

Initiative - Evaluate applicant’s ability to undertake new responsibilities

Poor

Average

Above Average

Excellent

Emotional Stability - Consider how applicant reacts in stressful situations

Somewhat Unstable

Fairly Well Balanced

Usually Well Balanced

Well Balanced

Poise - What is the applicant’s public demeanor?

Lacking in self-confidence

Exhibits little self-confidence

Moderately self-confident

Extremely self-confident

Leadership - Evaluate applicant’s leadership qualities

Never leads

Fair

Average

Exceptional

Responsibility - How well is applicant able to assume responsibility?

Unable to Assume

Fairly Responsible

Average – takes some initiative

Very Responsible

Teamwork - Evaluate applicant’s ability to function in a team relationship

Works best alone

Works fairly well with others

Works well with others

Works exceptionally well with others

Communication/Ability to Articulate - Evaluate applicant’s ability to present thoughts with logic, facility, and clarity

Not able to communicate clearly

Occasionally misunderstood

Usually clear and logical

Superior logic and communication

How long have you know the applicant?

Briefly describe your relationship with applicant:

What are applicant’s strengths?

What are applicant’s weaknesses?

Does applicant have the necessary knowledge, skills, and desire to succeed?

Overall Reputation:

Great

Good

Fair

Poor

Briefly describe how applicant handles and responds to authority:

Is applicant teachable?

Consistently

Sometimes

Not Usually

Additional Comments:

I recommend applicant:

Strongly

With Reservation

Not be Accepted

Why:

COA Scholarship Reference