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Tel. No.: (08822) 723116; (088)8583116 Locals 2054, 2055 Email: admissions@xu.edu.ph Website: www.xu.edu.ph

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Applicant’s Name: _______________________________________________________________________

Last Name First Name Middle Name

School: __________________________________________________________________________________
Residential
Resdiential Address: ______________________________________________________________________

TO THE APPLICANT: Write your name and address above. Choose two persons
who know you well and have held positions of authority over you in your pres-
ent school; e.g., your subject teacher, adviser, or principal. Give a copy of this
form to each of these two persons. Provide each of them with an envelope.

Above Average Below No Chance

average Average to observe
Ranking- as of first semester of senior year
1. Intellectual Ability
a. Number of students in class or section: _____
2. Communication Skills: Oral
Ranking of class or section: _______
Written
Top 10: ____________ Upper Third: ________
Middle Third: _______ Lower Third: ________ 3. Diligence in study habits

4. Ability to work with others

b. Number of students in whole graduating
5. Leadership Ability
class: __________
6. Service: School
Ranking in whole graduating class: __________
Community
Top 10: ____________ Upper Third: ________
Middle Third: _______ Lower Third: ________ 7. Integrity

8. Emotional Stability

TO THE PERSON RECOMMENDING: The candidate above is an applicant for a Xavier

University Scholarship. The Scholarship Board would appreciate your opinion on the points
stated below to aid them in evaluating the applicant. Please make your judgement carefully.

After accomplishing this form, please put in an envelope, seal, and sign on the
flap of the envelope before returning it to the applicant. Unsealed and unsigned
recommendation will not be accepted. Many thanks for your cooperation.

Please check one: Name of Recommending Person (Please Print)

___ I strongly recommend the candidate for a scholarship.
___ I recommend the candidate for a scholarship. ______________________________ ___________________
___ I recommend, with reservation, the candidate for scholarship. Name Signature
___ I do not recommend teh candidate for a scholarship. ______________________________ ___________________
Position Contact Number

____________________
Date