University of North Texas s4

UNIVERSITY OF NORTH TEXAS
DEPARTMENT OF KINESIOLOGY, HEALTH PROMOTION, AND RECREATION
SCHOLARSHIP COMMITTEE APPLICANT'S REFERENCE FORM (SCARF)

Dear Applicant: Please print your name:______Date:______

Please ask an individual (e.g., faculty member, employer) familiar with one or all of the following, to provide the requested information on the SCARF form below:
NOTE: family members are not allowed to serve as a reference.

· your academic performance,

· work or professional experiences, and

· character.

The combination of all three SCARF references must address the three areas listed above. Along with this SCARF form, provide each reference with a copy of your completed application packet. Please ensure each individual receives these documents at least three weeks before the application deadline, and the SCARF’s are mailed directly to the Scholarship Committee at the address provided on the back of this page. Please note, Scholarship Committee members are not allowed to serve as one of your three references.

RECOMMENDATIONS INCLUDED: U.S. Public Law 90-247 permits a student's access to certain educational records, including letters of recommendation. Section 438(a)(2)(B) allows you to waive your right of access to specific records. If you choose to waive your right of access to any letter of recommendation associated with this application, you must sign below. If you sign, the letter becomes confidential and you will not be entitled to read it. If you do not sign, you maintain your right to read the letter.

I choose to waive my right of access to this form by placing my signature below.
Signature:______Date:______

Dear Reference: The above individual is applying for one or more KHPR Scholarships (see application form). You must use this reference form in lieu of writing a letter.

1. Background
Print Name:______Position:______
Institution/Department:______
Address:______
Tel., Fax, and Email:______

2. Knowledge of applicant - Please check all that apply.
____ This student has enrolled in my class(es).
____ I have been this student's advisor.
____ While I have not taught or advised this student, I have known the applicant for ____ years and ____ months.
____ I have supervised or directed this applicant's work for _____ years and ______months.
____ I do not know this individual well enough to evaluate.
____ Other (please describe): ______

3. Evaluation - Check one box for each of the following characteristics by comparing the applicant to other students you
have known in the field.

APPLICANT’S CHARACTERISTICS / Top 5% / 5% -10% / 10%-25% / >25% / N/A
Grades
Breadth of general knowledge
Potential contribution to field
Leadership/interpersonal relations
Self responsibility/initiative
Demeanor, poise, representation of department/program
Attendance and punctuality
Interaction/participation in class
Honesty/integrity
Perseverance/determination
Profession related volunteerism
Profession related employment
Scholarly achievement (graduate students only)
Quality of presentations (graduate students only)
Overall Evaluation

4. Recommendation - Check the appropriate box.

I give my highest recommendation

I recommend strongly

I recommend

I recommend with reservations

I cannot recommend

5. Comments - Please add any comments that you feel would assist in evaluating the applicant's qualifications but
which have not been addressed with above questions.

Signature:______Date:______