Emerging Nurse Leaders Institute
Recommendation Form
Applicants Name: Last ____________________________________First___________________________
Please evaluate the application listed above by completing the following
information:
Ranking Scale:
5= Exceptionally High
4= Above Average
3= Average
2= Below Average
1= Do not know
Ability and Personality Traits
Personal Integrity
5
4
3
2
1
Social and Emotional
Ability to Work with
Peers
Ability to work with
other disciplines
Leadership Qualities
Oral Communication
Skills
Written
Communication Skills
Creativity
Indicate strength of your overall endorsement by checking the appropriate box:
______ Highly Recommended
______ Recommended
______ Recommended with reservation
______ Not Recommended
Please write additional comments that will aid in assessing the applicant’s
qualification:
Signature of Recommender_________________________________________________________________
Date: _______________________________
Please return the completed form to:
Kathleen Guiney RN MN
Kathleen.guiney@ucdmc.ucdavis.edu
Fax 916-703-9903