Use Acrobat Reader to type into this form. Select a shaded or underlined field. Print when finished. (This message won't print)
Western Illinois University
College of Education and Human Services
Department of Educational Studies
Education Specialist Degree Program Recommendation
Current Supervisor
To the applicant: Please type the name and address of the person from whom you are requesting a recommendation. Then fill in your
name, social security number, and program to which you are applying. Complete the form by signing and dating the Privacy statement in
the box. Send this form to the person, enclosing a stamped envelope addressed with the following address:
Educational Leadership Department
Western Illinois University
1 University Circle
Macomb IL 61455-1390
Name and address of person who will complete the recommendation: ____________________________________________________
___________________________________________________________________________________________________________
Applicant's Name: __________________________________________
Program applied for: _______________________________________
Privacy Statement
The undersigned hereby acknowledges and agrees that in consideration for the sending of a letter of recommendation by
_________________________________ that the undersigned waives any right or privilege to inspect or challenge the content and
comments expressed therein and that such observations shall be and remain confidential as between the writer and the WIU Education and
Administration Department.
Date: ____________________________________
Signature of Student _______________________________________________
Dear Colleague:
The above named person is an applicant for admission to the program indicated. We would appreciate your assistance in rating
him/her by checking the appropriate box in the rating scales below the heading that most nearly describes this person in comparison with a
representative group of employees in this field.
Below
Average
Lowest 40%
Applicant's ability as a scholar
1. General Knowledge
2. Ability to speak clearly
3. Ability to write clearly
4. Ability to do independent research
Average
Good
Outstanding
Unknown
Middle 20%
Highest 25%
Top 5%
Inadequate
Opportunity to
Observe
Reviewed February 14, 2005
Use Acrobat Reader in this section, by selecting/clicking the box that best describes the applicant. Otherwise, it will print in the current location.
Lowest 40%
Middle 20%
Highest 25%
Top 5%
Inadequate
Opportunity to
Observe
Below
Average
Lowest 40%
Average
Good
Outstanding
Unknown
Middle 20%
Highest 25%
Top 5%
Inadequate
Opportunity to
Observe
Personal Characteristics
1. Self-reliance and independence
2. Leadership
3. Emotional stability and maturity
4. Participation as a member of the community
5. Personal appearance and dress
Administrative Potential
1. Effectiveness and initiative
2. Enthusiasm and ability to motivate others
3. Management ability
4. Administration
5. Potential to become an effective superintendent
Please add any additional comments, which will help in determining whether this applicant should be admitted to the program.
Signature ________________________________________ Position _________________________________________________
Please indicate below:
1. Length of time you have known applicant _______________________________________________________________________
2.
In what capacity ___________________________________________________________________________________________
Thank you.
Educational Studies
Western Illinois University
1 University Circle
Horrabin Hall 81
Macomb IL 61455-1390
(309) 298-1070
Reviewed February 14, 2005