LETTER OF RECOMMENDATION FORM
Please Note: References by personal friends are not acceptable.
Applicant's Name:
Type or Print
Consent Signature
Date
The person listed above has applied for consideration as a degree candidate in Counseling and must provide three
reference assessments. The signature above authorizes you to complete this form. Your assessment will assist the
faculty in determining an admission decision relative to degree status. All information submitted will be viewed as
CONFIDENTIAL and will not be open to the candidate.
Please complete both sides of the DEGREE CANDIDATE REFERENCE ASSESSMENT FORM and sign.
Reference's Name:
Position/Title:
Business Address:
Business Phone: (
)
How long have you known the candidate?
In what capacity?
1. Candidate's specific STRENGTHS as a potential counselor?
2. Candidate's potential AREAS OF GROWTH as a future counselor?
3. Overall assessment of candidate as a COUNSELOR TRAINEE in our graduate program?
PLEASE COMPLETE THE RATING FORM ON THE NEXT PAGE AND SIGN
Please rate the candidate compared to other potential Counselor Trainees you have known/worked with/supervised
by circling the most accurate response. Please note that a 4, 5, 6, or 7 would constitute an AVERAGE response.
Use "Don't Know" ONLY if you have never observed or have absolutely no knowledge of the respective variable!
Don't
Know Lowest
AVERAGE
Highest
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Relationship Ability
Communication Skills
Sense of Responsibility
Empathy/Understanding
Warmth/Acceptance
Openness/Genuineness
Honesty/Integrity
Cooperation with Others
Sensitivity to Others/Diversity
Recognition of Limits
Ability to be Objective
Self-Assessment/Insight
Flexibility/Adaptability
Time Management/Efficiency
Sense of Humor/Perspective
Self-Reliance/Confidence
Aspiration/Motivation
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Knowledge of Real World
Eagerness/Enthusiasm
Energy/Industriousness
Leadership Ability
Goals/Direction/Purpose
Emotional Stability
Ability to Cope/Adjust
Crisis/Problem Solving
Punctuality/Sense of Time
Intellectual Capacity
Maturity Level
Acceptance of Supervision
Positive Attitude/Optimistic
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Signature
Complete and Mail to: Office of Admissions-Grad Admissions
002 Gilchrist Hall
Cedar Falls IA 50614-0018
or send via email admissionsprocessing@uni.edu
Date