XAVIER UNIVERSITY
OFFICE OF RESIDENCE LIFE
3800 Victory Parkway
Cincinnati, OH 45207
Phone: 513-745-3203 Fax: 513-745-2837
RESIDENT ASSISTANT APPLICANT RECOMMENDATION FORM
Name of Applicant: __________________________________________________________________________________
TO BE COMPLETED BY APPLICANT
TO BE COMPLETED BY THE APPLICANT
I request that __________________________________ complete this form as a reference in support of my candidacy for the
Resident Assistant position. Under the provisions of the Family Educational Rights and Privacy Act:
□ I have retained my right to access to this reference.
□I have waived my right to access to this reference.
APPLICANT'S SIGNATURE: ___________________________________________________
DATE: ______________
Reference
The Resident Assistant at Xavier University is a student who has been selected and trained to assist students in their adjustment
and integration into community living. RAs are responsible for communicating information, planning and implementing social and
educational programming, peer counseling, enforcing regulations, maintaining an environment conducive to learning and identifying
and assisting residents with personal and academic concerns.
Inherent in this position is the need to act as a role model for other residents and to live a life style congruent with job
responsibilities as a Resident Assistant. By virtue of your relationship with the candidate, you may be able to supply important
information which we might not obtain from the application materials or from the interviewing process. Thank you for your
assistance.
Under each category below there is a brief statement. Based on the following statements, please rate the applicant using the scale
below (Circle your responses)
Key:
SA=Strongly Agree,
D=Disagree,
A=Agree,
SD=Strongly Disagree,
N=Neutral,
N/A=Not Observed
OBJECTIVITY
SA
A
N
D
SD
NA
SA
A
N
D
SD
NA
Demonstrates the highest level of respect for self and others
Willing to solicit ideas and engage students in conversations
Demonstrates appreciation for differing opinions
Appreciates different ideas, lifestyles, and backgrounds
Displays attributes of self-respect and integrity
Engages him/herself in selected environments (school, work, etc.)
Comments:
ROLE MODEL
Is open minded and flexible to new ideas, people and learning
Demonstrates ability to teach acceptable and appropriate behavior
Demonstrates empathy towards students/colleagues
Sets a positive example for others to follow
Comments:
TEAMWORK
SA
A
N
D
SD
NA
SA
A
N
D
SD
NA
Committed to the achievement of group goals
Demonstrates effective communication skills, both oral and written
Is organized and displays effective time management skills
Able to prioritize multiple tasks
Understands when it is appropriate to lead and when to follow
Is comfortable with confrontation, listening and conflict resolution
Comments:
POSITIVE ATTITUDE
Is enthusiastic and positive about his/her current role (job, class, etc.)
Displays a positive attitude towards institutional or job expectations
Displays ability to support the needs of others
Displays ability to motivate others
Focuses on personal achievements and learning new things
Demonstrates a desire and willingness to seek out help
Comments:
0-1
1-3
3-5
5-7
Other
How many years have you known this applicant?
In what capacity do you know this applicant? Please list.
What are the strengths of this applicant?
What are this applicant’s areas for growth?
Comments:
For the items below, please pick only one category. Please explain your response to this category in the space provided.
____I Highly Recommend this Applicant
____I Recommend this Applicant
____I Recommend this Applicant with Reservations
____I Do Not Recommend this Applicant
Comments:
I, the reference writer, submit this statement to the Xavier University Office of Residence Life in full accord with the conditions
set forth by the applicant on this form.
Name:______________________________________
Position:____________________________________
Organization:________________________________
Phone: _____________________________________
E-mail Address:___________________________________________________________________________
Signature:__________________________________
Date:_______________________________________
Please return this form to the applicant. If the student has waived his/her right to access the reference, please submit in a sealed
envelope. Also, please sign your name over the seal to ensure confidentiality.
Residence Life Personnel only:
SA
This applicant has affected the floor/hall/building community
Displays a positive attitude towards the Office of Residence Life
Comments:
A
N
D
SD
NA