Shawnee Community College-TS

1. I would like to nominate this student to participate in TRiO Educational Talent Search.

Name*

First NameLast Name

School

Grade

2. My assessment of the student's performance is (circle one):

3. Student has been on the honor roll this semester or year?

YesNoUnsure

4. Please select the characteristics (in each row) which best describes the student. Feel free to be honest. Your assessment will not necessarily negatively influence student selection.

A

(4) Always complies with request promptly(3) Usually complies with request promptly(2) Usually slow in complying with request(1) Often fails to comply with requests

B

(4) Assertive, often takes initiative(3) Sometimes takes initiative(2) Rarely takes initiative(1) Passive, never takes initiative

C

(4) Very social and outgoing(3) Moderately outgoing(2) Shy, but not withdrawn(1) Withdrawn, limited communication

D

(4) Consistently displays a positive attitude(3) Usually displays positive attitude(2) Displays an indifferent attitude(1) Often displays hostile attitude

E

(4) Begins work immediately and works diligently(3) Works well most of the time(2) Usually has to be asked to do work(1) Has to be monitored to get work done

F

(4) Prompt, on time(3) Usually on time(2) Often late(1) Usually late

G

(4) Good attendance(3) Average attendance(2) Poor attendance

H

(4) Conscientious(3) Usually conscientious(2) Often haphazard(1) Doesn't care

Please state why you feel this student is a good candidate for the TRiO Educational Talent Search Program. (You may attach additional sheet if desired.) (4pts)

Total Points

This student is on free or reduced lunches.

YesNoUnsure

This student is an average or above student.

YesNoUnsure

This student parents have 4-yr college degrees.

YesNoUnsure

Name of person completing this form

First NameLast Name

Position/Job Title

Daytime Phone

(999)999-9999

E-mail Address*

example@example.com

Fax Number

Signature

Name*

First NameLast Name

Date

mm-dd-yyyy

THIS INFORMATION IS CONFIDENTIAL AND WILL NOT BE RELEASED TO A THIRD PARTY.

WE SINCERELY APPRECIATE YOUR COMPLETING THIS FORM.