Midland Conservation District

Scholarship Reference Questionnaire

THREE (3) References Required

Date:

Your Name:

Your Address:

Telephone Number: ( )

Profession:

Applicant’s Name:

How many years have you known the applicant?

In what capacity? □ Friend □ Neighbor □ Teacher □ Business Associate

Is this applicant active in community affairs? □ YES □ NO

Your evaluation of the student’s character and abilities (strong points, weak points, etc.):

Please return to Midland CD at 275 W. Saginaw Rd., Sanford, Michigan, 48657