FLOYD-LYON  MEMORIAL KIWANIS SCHOLARSHIP

                                                             REFERENCE FORM # 2
                   To be completed by Employer, Community Leader, Family Friend

Applicant’s name: ___________________________________________	

Name of Reference: _________________________________________

Type of Reference (please check one):      Employer __    Community Leader __    Family Friend __

Reference’s address___________________________________________   

City and state _______________________________________________    Date ______________

Thank you in advance for your assistance. Your evaluation of this student will be most helpful to the Floyd-Lyon Memorial Kiwanis Scholarship Committee in awarding this scholarship. All information you provide will be held in strict confidence.  

1.	How do you know the applicant?

2.	a.  Based on the qualities of honesty, intellectual curiosity, contributions to his/her school and community, and motivation, what is your opinion of the applicant’s probable success in furthering his/her education? 
			
				Poor____,   Average ____,   Above Average ____,   Excellent _________ .

b. Please explain why you feel this way about the applicant, Use the reverse side of the form if necessary.

                                                                    Signature of Reference ____________________________________

DEADLINE:  This completed form must be returned to your high school guidance office by the end of the school day on Friday, March 05, 2021