Reference Form

Choose type of reference:
Academic ReferenceNon-Family Personal Character ReferenceNursing Supervisor Reference
Applicant:
Please read the paragraph below very carefully and check off either confidential or non-confidential in the appropriate space prior to giving this form to the individual writing the recommendation.

Name of Applicant:

The applicant has chosen this statement to be...

ConfidentialNon-confidential

...according to the Family Education Rights and Privacy Act of 1974. Confidential references are prepared for the use of the director of graduate admissions only, and should not be shown to the candidate. Non-confidential references may be viewed by the candidate.

The following information will be used in making an evaluation of the applicant’s strengths and weaknesses as related to graduate study.

1. In what professional and/or personal capacity and for how long have you known the applicant?

2. How well does the applicant express himself/herself verbally? In written forms?

3. Please comment on the applicant’s analytical ability and research skills.

4. Please discuss any special factors in the applicant’s background which demonstrate motivation and preparation for graduate work.

5. Please make any additional comments you may have about the applicant’s record, personal qualities, academic ability, critical thinking, and ability to apply research findings in clinical practice.

6. Please indicate your evaluation of each of the criteria using the following rating scale:
4 = Excellent, 3 = Above Average, 2 = Average, 1 = Below Average, N/A = Not Applicable

Please check one:
I recommendI do not recommend for admission to graduate study
Comments:

Signature:

Date:

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