Henry Street Settlement Youth Scholarship

Henry Street Settlement Youth Scholarship
Student Evaluation Form
Instructions to the applicant: Fill out the first line and give this to a HSS staff member who knows
you well.
Applicant Name
HSS Program
Instructions to HSS staff member: This student has applied for a Henry Street Settlement Youth
Scholarship and has chosen you to evaluate his/her participation in your youth program. The scholarship
committee finds candid evaluations very helpful in choosing deserving students among the many
applications. We ask that you are as specific as possible to ensure the best appraisal of the applicant.
Please use an additional sheet of paper if necessary. For your convenience, this form is also available
on the Adolescent Services page of the HSS website. Thank you in advance for your attention to this
matter.
How long and in what capacity have you known the applicant?
In your estimation, has the student taken advantage of both the academic and recreational offerings within
the Youth Services Division of Henry Street Settlement? If so, how?
On a scale of 2-5, 2 being poor and 5 being great, rate the applicants overall demonstration of the
following:
Poor (2) Satisfactory (3) Good (4) Excellent (5)
Personal responsibility
Relationships with peers
Ambition and Motivation
Leadership
TOTAL
What about this applicant stands out? Why should they be considered for this scholarship?
(If necessary, use additional sheet of paper)
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