University of Wisconsin - Stevens Point
College of Professional Studies
School of Communicative Disorders
Center for Communicative Disorders
1901 Fourth Avenue
Stevens Point WI 54481-3897
School 715-346-2328
Center 715-346-3667
Fax 715-346-2157
www.uwsp.edu/comd
Recommendation Form
APPLICANT: Ask the person writing a recommendation for you to use this form. Provide the
following information to this person before giving the form to him/her.
Name of Applicant: (please print)
I do ____ do not ____ (check one) waive my right of access to this reference letter.
Applicant signature:
Date:
DUE DATE for Fall 2015 enrollment: Monday, January 12, 2015.
Referee: Please complete the items on this form as well as a narrative describing this applicant.
As a student in my class(es), this person ranks in the:
Top 10% _____ Top 20% _____ Top 30% _____ Top 50% _____ Unknown
As a student clinician, this person ranks in the:
Top 10% _____ Top 20% _____ Top 30% _____ Top 50% _____ Unknown _______
This student's ability to work independently is:
Superior _____ Excellent _____ Good _____ Adequate _____ Unknown
_______
This student's interpersonal communication skills are:
Superior _____ Excellent _____ Good _____ Adequate _____ Unknown
_______
Proactive • Resourceful • Connected • Caring
Accounting • Athletic Training • Athletics • Business Administration • Clinical Laboratory Science • Communicative Disorders • Dietetics • Economics • Education
Family & Consumer Sciences • Health Promotion/Wellness • Health Sciences • Interior Architecture • Military Science • Nursing • Physical Education
2
Please check only one of the following categories.
____ A. OUTSTANDING CANDIDATE. A graduate program should actively seek to recruit this
student.
____ B. STRONG CANDIDATE. This student is above average and will do well.
____ C. ACCEPTABLE CANDIDATE. Guarded optimism for success, might need support.
____ D. UNACCEPTABLE CANDIDATE. Unlikely to succeed at the graduate level.
____ E. I do not have sufficient data about the student to use one of the categories (A-D).
Comments: Please comment on the student’s potential for success in graduate school as well
as her/his academic/clinical performance and experience on a separate page.
Please include your information below.
Name (please type or print):
Position:
Address:
Signature: _________________________________________________________
Date:
Please send this recommendation to:
Coordinator of Graduate Programs
School of Communicative Disorders
University of Wisconsin-Stevens Point
Stevens Point, WI 54481
715-346-2157 (fax)