Reference Form

Student Name(Required)

This document is intended as a reference check for an applicant for the Fern Helbling Scholarship that is coordinated through the Black River Area Chamber of Commerce. Fern Helbling stressed that the student have good moral standards and an unquestionable reputation. Please comment on these two important factors. Please rate the student on these two areas – 1 through 5, with 5 being the highest

Morals(Required)

Reputation(Required)

Tell me why you feel this person will be successful in completing their chosen field of study?(Required)

Do you have any additional comments?

Reference Signature(Required)

Relationship to Applicant(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

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Reference Form

Reference Form