Designated High School Official Reference – New York Rabbit & Cavy Breeders Association

Designated High School Official Reference Form

NAME OF YOUTH SCHOLARSHIP APPLICANT:

First

Last

The above named student, an applicant for the NYR&CBA Youth Scholarship, hereby requests that you, as their Designated High School Official, fill out this form completely and submit it PRIOR TO AUGUST 31st.

Address of Youth Scholarship Applicant:

Address Line 1

Address Line 2

City

State

Zip Code

Name of Designated High School Official:

First

Last

Position / Title of Designated High School Official:

Email

Phone

Name of High School:

Address of High School:

Address Line 1

Address Line 2

City

State

Zip Code

In what manner do you know the applicant?

Has the applicant shown serious shortcomings of any kind, including: disciplinary, attendance, social, scholastic and/or other?

Yes
No

If yes, please explain:

To be eligible for the NYR&CBA Youth Scholarship, this applicant must have a GPA high enough to be accepted by an accredited college/university or vocational school. Is this applicant eligible under this provision?

Yes
No

GPA of Student:

Comments

Certification:

By checking this box and signing below, I certify that, to the best of my knowledge, all statements contained in this Referral are true and correct.