PHI DELTA KAPPA – ECU Chapter

Application Recommendation FormGraduating High School Senior

TO BE COMPLETED BY THE APPLICANT

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Last NameFirst Name M.I. Social Security Number

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Street AddressCityState Zip Code

*The Family Education Rights and Privacy Act of 1974 and its amendments guarantee students accessto their official educational records. This right extends to letters of recommendation written on or afterJanuary 1, 1975. A student may waive his/her right to inspect and review letters of recommendation bysigning a waiver. The following statement indicates the wish of the student requesting this particularrecommendation.

____ I waive any right to inspect the content of this letter of recommendation.

____ I do not waive my right to inspect the content of this letter of recommendation.

______Applicant’s Signature Date

**Submit only two recommendation forms from professional references such as instructors, academiccounselors, employers, etc. One reference must be from a recent instructor or academic counselor.

Finalists cannot be selected without this recommendation form. Applicants are responsible to see that this form is received by the Scholarship Committee prior to the stated deadline.

TO BE COMPLETED BY THE RECOMMENDER

This form should be completed by a high school, church, or community leader who knows the student wellenough to answer questions about his/her leadership skills. The recommender must not be related to theapplicant. This recommendation must be received by February 15th. The student identified above has applied for a Phi Delta Kappa Education FoundationScholarship. Phi Delta Kappa – East Carolina University Chapter awards outstanding students with proven leadership skills and potential as a future educator.

Please return this completed recommendation to: Phi Delta Kappa – ECU Chapter Scholarship Committee,

Mary Edwards, PO Box 637, Winterville, NC 28590.

Please respond to the following questions:

1. How long have you known the applicant?______

2. What is your relationship to the applicant? Academic Personal Employer Other ______

3. I know this applicant: Extremely WellVery WellModeratelyWellNot Well At All

4. Do you believe this applicant has the ability and determination to complete his/her educational

objectives?Yes No Unknown

5. Based on past and current performance, how do you describe the candidate? (Place aor in front of your response.) ____ A. Not viewed as a leader ____ B. Below average student leader ____ C. An average student leader ____ D. Above average student leader

____ E. Excellent leader, one of the best I’ve ever known

6. How do you rate this applicant based on the following attributes?

Attributes / No Basis For Judgment / Poor / Below Average / Average / Above Average / Outstanding
Academic Progress (Grades/Quality Of Work)
Ability To Work With Peers
Dependability/ Reliability
Promptness/ Attendance
Enthusiasm/ Motivation
(Initiative, Resourcefulness)
Work Ethic
Honesty/ Integrity
Time Management Skills
Organizational Skills
Oral Communication Skills
Attitude
Professionalism
Potential For Success
(Ability To Set And Achieve Goals)

7. Please comment on the applicant’s abilities, limitations, performance in school and/or within anorganization, andpotential for future positions of leadership.

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Reference’ Signature Date

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Name (print) TitleTelephoneEmail Address

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Street AddressCityStateZIP