Freddye T. Davy Scholarship Reference Form

The individual named below is applying for the Freddye Davy Scholarship offered by the NCHC Diversity Committee. Please rate the applicant according to criteria listed below. (with 1 being the lowest rating and 5 the highest)

1. You have been requested to complete a reference form on behalf of

2. Performs well in Honors Program/College coursework

1

5

3. Actively participates in Honors Program College events

1

5

4. Actively participates in Honors Program College events

1

5

5. Actively participates in on-campus service benefiting students / institutionThis can include, but is not limited to, participation in student organizations, campus-organized outreach activities, etc.

1

5

6. Actively participates in off-campus service benefiting the greater communityThis can include, but is not limited to, participation in community organizations, non-profit agencies, outreach programs to diverse communities, international service.

1

5

7. Engages in scholarship outside the classroom

1

5

8. Needs financial assistance to attend NCHC Conference

1

5

9. Please provide a brief statement as to why you believe this student should be considered for the Freddye Davy scholarship. Please provide examples of how the applicant has contributed to your honors program, campus, and university. Also indicate the nature and duration of your relationship with the applicant (Dean, Faculty, Advisor, etc.)

10. Name & Title

First Name

Last Name

Title