American Shotcrete Association

(a Michigan NonProfit Corporation)

American Shotcrete Association
38800 Country Club Drive
Farmington Hills, MI 48331
Tel.: (248) 848-3780, FAX: (248) 848-3740

2011-2012 Online Reference Form

Statement of Appraisal of Applicant for:

ASA Graduate Scholarships

TO EVALUATOR:

Please completely fill out form below and submit by November 4, 2011.

Instructions: Each evaluator shall complete the form and submit it prior to November 4, 2011. If there are any questions, please contact Alice McComas at (248) 848-3780 or via e-mail at info@shotcrete.org.

*Name of applicant:

Applicant will be notified via email of this reference

*Email of Applicant

Currently enrolled at:

and/or employed by:

*Name of evaluator:

*Phone:

*Email:

*Address:

*How long have you had personal contact with the applicant?

From to

*Under what circumstances?:

*From your knowledge of the applicant’s performance, please check the box next to your rating of the applicant’s standing in comparison to others in similiar circumstances.

Leadership