DMP Scholarship - Personal Rating Form

For use by teach, counselor, or community leader

Name of applicant:
School:
How long have you known the applicant and what is your direct association?
If you are a teacher, what was the applicant’s grade in your course
Which of the following statements most nearly describes the applicant?

Which of the following statements most nearly describes the applicant? An exceptionally hard-working person A highly intelligent person who does not work to the full limits of capabilities A highly intelligent and exceptionally hard-working person Other (state in your own words) Other (state in your own words)

Please rate based on your knowledge of this applicant’s potential for success in college:
	Fair	Good	Exellent	One of the very top students I’ve encountered
Academic	AcademicFair	AcademicGood	AcademicExellent	Academic
Promise	PromiseFair	PromiseGood	PromiseExellent	Promise
Character & Personal Promise	Character & Personal PromiseFair	Character & Personal PromiseGood	Character & Personal PromiseExellent	Character & Personal Promise

Please add any information that might be helpful to the selection committee:
Teacher, Counselor, or Community Leader
Your Name: Your Name: Title First Middle Last Suffix
Position:
School or other institution:
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Draw your signature into the box below.

Draw or Type

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Full Name

I understand this is a legal representation of my signature.
Date Signed: Date Signed: / MM / DD YYYY