APPLICANT STATEMENT TO WRITER:
I request that you, ______________________________________, complete in the space below a statement of recommendation
to supplement my application for admission to the Teacher Preparation Program at Central Washington University. Your candid
evaluation of my strengths and weaknesses for admission to the Teacher Preparation Program is requested. Under the
provisions of Part 99 of Title 34 of the Code of Federal Regulations on the confidentiality of the completed statement, the
applicant named below has selected one of the following two options (a) or (b) by initialing below in one of the appropriate
spaces.
_______ (a) I understand the completed statement will be held in confidence from me by the Certification Office.
_______ (b) I understand that I have the right to inspect and review the completed statement at the Certification Office.
Applicant Signature_________________________________________________________ Date_________________________
Printed Name_________________________________________________ Area of Study_______________________________
The above to be completed by the applicant
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - WRITER'S STATEMENT OF RECOMMENDATION: How long have you known applicant?______________________
In what capacity?___________________________________________ Number of credit hours taken from you?_____________
Please rate the applicant for his/her potential
as a teacher.
Outstanding
(5)
Well Above Avg.
(4)
Above Avg.
(3)
Average
(2)
Below Avg.
(1)
No
Knowledge
Speaker - uses effective language and style to
communicate
Writer - effectively demonstrates standard writing
conventions
Motivator - enthusiastic, a capacity to inspire and
motivate others
Achiever - goal oriented, consistently produces
quality work
Facilitator - helpful, desire to assist others,
patient, empathetic, reflective
Leader - a sense of self-confidence, can actively
engage others, good listener
Supporter - works cooperatively with others in
pursuit of a task or goal, responds to other's
feelings and needs
Overall potential as a teacher - exhibits
attributes essential to effective teaching
COMMENTS AND RECOMMENDATIONS: (On the back side of this form, please include personal knowledge of applicant's
professional experiences and/or achievements that suggest success as a teacher. Describe any opportunities where you
observed the applicant working with students.)
Writer Signature_______________________________________________________________Date_______________________
Printed Name___________________________________________________Position__________________________________
Address________________________________________________________________________________________________
Organization________________________________________________________Phone #______________________________
Return to: C W U Certification Office, 400 E. University Way, Ellensburg, WA 98926-7414