CAMC Foundation Nursing / Allied Health / Medical Student Scholarship - Reference Form

CAMC Foundation Nursing / Allied Health / Medical Student Scholarship

CAMC Employment Center
CAMC Foundation Nursing/Allied Health/Medical Degree Scholarships
Attention: Lavonda Williams
Post Office Box 1547
Charleston, WV 25326

Reference Form

We would appreciate it if you would furnish us with as much of the information requested as possible. the information given to us will be held strictly confidential. We would appreciate your prompt attention to this matter.
Name:		Date of Graduation:
Signature of applicant		Major:
Degree Pursuing:	Associate Bachelor Master Doctorate
Please rate the applicant on the following:

Characteristics	Outstanding	Above Average	Average	Below Average	No Opportunity To Observe
Dependability
Problem Solving Ability
Ability to Work in a Team
Ability to Work Independently with Minimal Direction
Cooperativeness
Initiative

In what capacity do/did you know applicant?
Additional Comments:

Signature of person providing reference:		Date:
Title:		Phone:
Institution:
Address: