Reference form for scholarship applications

Please use your personal knowledge of the applicant to respond to the following: 5=excellent, 4=good, 3=satisfactory, 2=fair, 1=poor, xx=no opinion

How long have you known the applicant and in what capacity?
In your opinion, what personal strengths will enable the applicant to be successful in her college endeavors?
Do you feel this aplicant is a worthy recipient for this scholarship? Please explain.
What else would you like us to know about this applicant?
Name
Date / Time