Recommendation for the MDIV or MATS/MSW Program

Applicant Name *

REFERENCE INFORMATION

Reference Name: *

Daytime Phone: *

Title *

Organization: *

Occupation: *

Email Address: *

How long have you known the applicant? *

How well do you know the applicant? *

Very Well

Well

Minimally

In what capacity do you know the applicant? *

Please rate the applicant. *

	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Written Communication	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Intellectual Ability	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Leadership	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Ethics	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Empathy	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Reliability	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Judgement	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Interpersonal Relations	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Professional Appearance	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Team Skills	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Conflict Resolution	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Reaction to Criticism	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed
Overall Evaluation	Excellent (5)	Good (4)	Average (3)	Below Average (2)	Poor (1)	Not Observed

Please attach a letter of reference.

Recommendation Concerning Admission: *

I highly recommend this applicant.

I recommend this applicant.

I recommend this applicant with reservations.

I do not recommend this applicant.

Thank you for your responses. If you have received this recommedation request, the student has waived the right of access for this reference.

Sincerely,

Amber B. Kustos

Director of Graduate and Undergraduate Student Services

School of Public Health

Samford University