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Atrium Scholarship Renewal Form
This renewal form to the scholarship selection committee is required for those seeking the continuation
of scholarship benefits. Continuation is dependent upon the student’s work progress, supervisor
evaluation, and maintaining a GPA of 2.5, (graduate, GPA of 3.0). The Scholarship Committee will review
this form and the supervisor’s recommendation before making a decision.
Please return this form to Lynn Patterson by Tuesday, April 24, 2015
Name of Scholarship Recipient: __________________________________________________________
Area of Employment in the Library: ________________ Projected Graduation Date: ________________
Supervisor: ___________________
Scholarship Donor: _______________________
If scholarship renewal is approved, the student agrees to the following conditions:
•
•
•
Scholarship winners are expected to attend the Scholarship Luncheon Celebration to meet with
scholarship donor.
Scholarship winners are expected to allow essay and likeness to be used in library publicity
regarding the scholarship program
Scholarship winners are expected to write a letter of thanks to the scholarship donor upon
renewal.
I have read and agree to the conditions listed above.
I, ______________________________ would like to renew my scholarship as a part of the Library
Atrium Scholarship Program. I understand I must complete the answer the question posed below:
What would you like the committee to know your scholarship has impacted your educational
experience this year?
Signature of Scholarship winner: _______________________________________
Atrium Scholarship Renewal Form
Supervisor’s Recommendation
Supervisor’s Name: ___________________________________________________________
Student’s Name: _____________________________________________________________
Number of years you have worked with this student: ___________
Please evaluate the following characteristics (1 is low, 4 is high)
Job knowledge and skills
1
2
3
4
Attitude and teamwork efforts
1
2
3
4
Dependability
1
2
3
4
Quality of Work
1
2
3
4
Overall Job Performance
1
2
3
4
Please add any additional information concerning the continuation of this scholarship.
I believe that this student’s scholarship should _____ /should not ________ be renewed.
______________________________
Supervisor’s signature
_______________
Date
Please attach the supervisor’s recommendation and an unofficial copy of your transcript to the renewal
form and turn in by April 24, 2015
Please return completed forms to:
Lynn Patterson
PO Box 32026;
Belk Library and Information Commons;
Appalachian State University; Boone, NC 28608
Phone 828-262-2087; Fax 828-262-3001