Reference-Level II Social Work Program
Student Name:
_______________________
Student ID
____________
This student is applying to the junior level of the Social Work major at Edinboro University of
Pennsylvania. Applicants are required to obtain references from two faculty members outside the
Department of Social Work. We appreciate your candid assessment. If you have not had an
opportunity to observe a factor, please circle N/A.
Class Attendance
1
Frequent
absences
2
3
4
5
Rarely
absent
N/A
1
Arrives late
or leaves early
2
3
4
5
N/A
Consistently
on time, dependable
2
3
4
5
N/A
Assignments are
complete and on
time
2
3
4
5
Active and
appropriate
participant
2
3
4
5
N/A
Alert/attentive
enthusiastic
3
4
5
N/A
Clear,
few errors,
well structured
Organization of work
1
Work is often
late, asks for
extensions
Classroom Participation
1
Does not
participate;
Inappropriate
comments
N/A
Engagement in class
1
Inattentive
Uninvolved
Written Communication
1
Vague, spelling,
grammar errors
poorly organized
2
1
Does not cite
sources
2
3
4
5
N/A
Uses APA/other
citations/style
3
4
5
N/A
Clearly articulates
ideas, thoughts
1
2
Appears
judgmental, intolerant
3
4
5
N/A
Respectful,
non judgmental
1
Has difficulty
with others
2
3
4
1
2
Has difficulty
accepting constructive
criticism
3
4
Verbal Communication
1
2
Difficulty expressing
self
Interpersonal skills
5
N/A
Works cooperatively working
with others
5
N/A
Accepts criticism
Additional comments that will help us to determine the student’s capacity for preparing for and
practicing in the social work profession.
________________________________________________________________________
Faculty member completing form:
Name (Please print)
_____________________
Class(es) where applicant was a student:
Department:
__________________
____________________________________
Signature: ____________________________________________ Date: _____________