Baxter International Foundation Scholarship Program Applicant Appraisal/Academic Record Form

Please complete the following information so this form can be matched to your electronic application.

Applicants Name (print or type)

Applicants Mailing Address

Application ID# (see email notices or your e-app) BAXTER -

To the Student Applicant: Print this page and provide to the appropriate individuals.
This information is required and must be completed in the format provided below. If incomplete, your application will not be evaluated. The
appraisal is to be completed by a counselor or advisor, an instructor, or a work supervisor who knows you well.

Upload the completed form and a current complete transcript of grades before submitting, no later than March 1, 2017.
Applicant Appraisal
To the Adult Appraiser: You have been asked to provide information in support of this application. Please give immediate and serious
attention to the following statements. When complete, please return to applicant. This form must be uploaded before submitting the
application. A letter of recommendation does not replace this section.
The applicants choice of a postsecondary educational extremely very appropriate moderately inappropriate
program is appropriate appropriate
The applicants achievements reflect his/her ability extremely well very well moderately well not well
The applicants ability to set realistic and attainable goals is excellent good fair poor
The quality of the applicants commitment to school and/or
community is excellent good fair poor
The applicant is able to seek, find, and use learning resources extremely well very well moderately well not well
The applicant demonstrates curiosity and initiative extremely well very well moderately well not well
The applicant demonstrates good problem-solving skills, follows
through, and completes tasks extremely well very well moderately well not well
The applicants respect for self and others is excellent good fair poor

Comments:

Appraisers Name Title Phone ( )

Signature Organization Date

Transcript Information
A transcript of grades must be uploaded in addition to this form. Grade reports are not acceptable. Transcripts must display student name,
school name, grade and credit hours earned for each course, and term in which each course was taken.
1. Students currently or previously enrolled in college or vocational-technical school must include all college or vo-tech transcripts of grades
from each school attended. (Completion of the high school information is not necessary.)
2. Students who have completed less than one full term, quarter, or semester of postsecondary education must include a secondary
school/high school transcript of grades and have this section completed by an appropriate school official. (A clear explanation of the
secondary school/high schools grading scale must also be submitted.)
U.S. applicants ONLY need the below completed by a school official.
Cumulative Grade Point Average SAT (US Only) ACT (US Only)
Applicant ranks _______ Critical
Weighted: __________/4.0 scale Math Writing English Math Reading Science Composite
Reading
in a class of __________
Unweighted: ________/4.0 scale

School Officials Signature Phone ( _______ )

School Officials Title Date

Name of School City State ZIP

Upload this completed form and transcript before submitting your application:

Deadline: March 1, 2017

If you have any questions, email: thebaxterfoundation@scholarshipamerica.org