Letter of Reference Form: Current Advisor
Name of Applicant:
Telephone:
Date:
______________________________
______________________________
______________________________
Name of Reference Provider: ______________________________
Title:
______________________________
Address:
______________________________
______________________________
Phone:
______________________________
Date:
______________________________
Email: ___________________
Email: ___________________
Under the provisions of the Family Education Rights and Privacy Act of 1974, you will have access to the
information provided unless you have waived such access. Please sign and date below to inform us of
your decision.
I hereby waive my right of access to the information
in this recommendation.
I do not waive my right of access to the information
in this recommendation.
_________________________
Signature of Applicant
_________________________
Signature of Applicant
_____________
Date
______________
Date
From: Eileen Ihrig, MSW
126 McGuinn Hall
140 Commonwealth Avenue
Chestnut Hill, MA 02467
Email: ihrig@bc.edu
Phone: 617-552-1612
Fax:
617-552-1095
We appreciate your assistance in helping us determining the student’s suitability for an international field
placement. Access to this material is restricted to appropriate faculty and to the student unless s/he has
waived the rights under P.L. 93-568, as indicated above. In assessing the applicant’s aptitude for the
field of international social work and working in a cross cultural setting, please frame her/his qualifications
for professional education in the context of the following questions.
I. Please rate the applicant in comparison with others whom you have known at a similar stage in their
careers.
Exceptional
Upper 5%
Outstanding
Next 15%
Very Good
Next 15%
Good
Next 15%
Poor
Next 15%
No Basis for
Judgment
Motivation & commitment to
social work
Motivation and
perseverance towards goals
Ability to work
independently
Ability to express thoughts
in speech and writing
Ability to work with people
of diverse backgrounds
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II. Kindly provide the following information to the best of your knowledge about the applicant.
A.
What do you know about her/his personality and ability to work with diverse populations and/or in
a cross-cultural setting?
B.
As international social work requires considerable physical and emotional stamina, we would
appreciate your observations on the applicant’s ability to work in stressful settings and to
withstand emotional strain.
C.
Describe observed talents, skills, and abilities the applicant has.
Would you recommend this applicant for working in an international setting doing social work?
Please explain your answer
Yes q
No
q
Please provide any additional information that you believe would help in determining the student’s ability
to undertake an international field placement.
Thank you for taking the time to complete this reference form.
Signature: __________________________________
Date: _____________________
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