Referee Form

Referee Form

Michael Goldbloom Excellence Scholarship
This form must be completed by the candidate's referee only. Reference forms will be reviewed by the Scholarship Committee for authenticity. To be completed and submitted no later than March 1, 2026.
Referee's First Name
Referee's Last Name
Referee's Email
Referee's Institution / Organization
Referee's Current Position / Title
Number of years in current position
Full Name of the student you are providing a reference for:

First NameLast Name
How long have you known the student?*

Less than one (1) year1-3 years3-5 years5+ years
Capacity in which you have known the student (e.g. Teacher, Academic Advisor, Mentor, etc.)

Comparing the applicant to other students in both their current cohort and other cohorts, please score the applicant on the following (select the best score for each category):*

	Top 1%	Top 5%	Top 10%	Top 15%	Top 20%	Top 25%	N/A
Academic Ability
Entrepreneurship
Community Engagement
Leadership Potential
Providing a positive impact on others

Please provide a brief statement which demonstrates and discusses the student's academic ability, community engagement, leadership capabilities, future potential and any relevant extenuating circumstances.*
This form is protected against SPAM*
Should be Empty: