Undergraduate Scholarshhip Programs Reference Form

OMB Control #0648-XXXX
Expires: XX-XX-20XX

National Oceanic and Atmospheric Administration
Undergraduate Scholarship Programs
Voluntary Reference Form

Professor
completing
form:

(Last Name)

(First Name)

(Middle Name)

(Last Name)

(First Name)

(Middle Name)

Applicant:

How long and in what association have you known the applicant?

Compared to other students of comparable age and experience you have known in the last five years,
how would you rate the applicant with respect to the following characteristics?
Below
Average

Average

Good

Very
Good

Exceptional

No Basis for
Judgment

Motivation and persistence toward a productive career
Imagination and originality of thought
Ability to work with others
Independence and self-reliance
Leadership potential
Mastery of fundamental knowledge in field
Ability to communicate (written/oral)

PAPERWORK REDUCTION ACT INFORMATION
NOAA conducts the Office of Education, Educational Partnership Program, Undergraduate Scholarship Program in order to promote the
education and training of students in NOAA sciences. The information contained in this application will be used to select undergraduate
students. The information on this form will not be treated confidentially. Public reporting burden for this collection of information is estimated
to average 8 hours per application including the time for reviewing the instructions and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the
burden, to NOAA Office of Education, Educational Partnership Program, 1315 East-West Highway, Silver Spring, MD 20910.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to
comply with, a collection of information subject to the requirements of the Paperwork Reduction Act, unless that collection of information
displays a currently valid OMB Control Number.

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Add any descriptive comments that will assist in providing a complete picture of the applicant’s abilities.
COMMENTS:

Signature:

Date:

Typed/Printed Name:

Title:

Department:

Institution/Organization:

Telephone:

E-Mail:

Mail application, transcripts, and completed reference forms by February 9, 2008, to:
NOAA/Hollings Scholarship Program
Office of Education
1315 East West Highway, Room 10703
Silver Spring, Maryland 20910

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