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is
applying for admission to the Bachelor of Social Work Program
at Missouri Western State University. The applicant and admissions
committee will appreciate your completing this form and returning
it to the applicant in the enclosed envelope by
,
20 . After sealing the envelope, please sign your name across
the flap. Mail the envelope to Social Work Program, Missouri
Western State University, 4525 Downs Drive, St. Joseph, MO 64507-2294.
Applicant's Statement: I am aware that
under the Family Educational Rights and Privacy Act of 1974,
I am not required to, but I may voluntarily waive my right to
access to confidential letters and statements submitted to Missouri
Western State University in support of my application to the Social
Work Program.
I hereby:
do
do not waive my rights of access to any and all letters or statements
of recommendation which may be submitted by
(applicant must specify name
of person submitting recommendation before sending form to that person) in
connection with my application to the Social Work Program, Missouri Western
State University. |
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Evaluator's Name: |
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Phone Number: |
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Name of Agency/School/Business:
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Title:
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Approximately how long have you known the
applicant? |
Years Months |
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How well do you feel you know the applicant? |
Casually
Well
Very Well |
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What was/is the nature of your contacts with
the applicant? |
Employer
Instructor in one
class
Friend
Co-worker |
Counselor
Instructor in more than one class
Minister
Supervisor of volunteer work
Other
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Please rate the applicant in the following
areas using the following 10-point rating scale: 0-1= Poor; 2-3
= Below Average; 4-6 = Average; 7-8 = Above Average; 9-10 = Exceptional;
D = Do Not Know |
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Knowledge
of social work field |
Ability
to initiate and follow through |
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Writing
Skills |
Problem-solving
abilities |
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Sense
of responsibility |
Commitment
to ethical behavior |
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Describe the applicant's qualities that will
contribute to her/his success in the social work profession and
that should be considered by the selection committee. |
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Describe any qualities of the applicant that
may deter her/him from becoming an effective social work professional. |
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Please express your views on any of the items
listed above or on any other relevant elements pertaining
to the applicant, if needed. |
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Overall, I would give: |
a very strong recommendation
a strong recommendation
an average recommendation
no recommendation, would not recommend
a recommendation with the following reservations
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________________________________
Signature |
________________________________
Date |