RECOMMENDATION FORM
Washburn University
Master of Arts in Psychology with an Emphasis in
Clinical Skills
Applicant's name
Name of reviewer
To the Applicant: Letters are required from three or more persons who know your academic
and personal abilities well. The most preferred letters are from former college instructors in
Psychology or from mental health professionals with whom you have worked. For the
convenience of the person completing this form, you should include a stamped, addressed
envelope.
Under the federal Family Educational Rights and Privacy Act of 1974, students are entitled to
review their records, including letters of recommendation. However, those writing
recommendations and those assessing recommendations may attach more significance to them if
it is known that the recommendations will remain confidential. (Confidential means that the
student formally gives up the right to see the recommendation.) Under this law, you may choose
to waive (give up) your right to see this recommendation, or you may decide not to waive your
right to see this recommendation.
By indicating below, I agree to waive, or not waive, my rights under FERPA to see this
recommendation.
I waive my right to review this recommendation.
I do not wave my right to review this recommendation.
Electronic Signature (include “/s/” before typing your name)
Date
ATTENTION APPLICANTS: Complete the portion of the recommendation form above this point
and then email this form to your reviewer. Your reviewer will email the completed letter
of recommendation directly to Theresa Young, secretary, Department of Psychology.
Her email address is: theresa.young@washburn.edu
To the Recommender: The information requested below will be used by our faculty in making
admission decisions. It is designed to facilitate efficient communication of information
which we feel may be relevant in making admissions decisions. If you would prefer to
write a letter, please address the basic information requested herein, and add any
information you wish to provide. Please feel free to append additional pages as needed.
1. I have known the applicant for
years,
months.
2. I know the applicant:
slightly well
fairly well
very well.
3. I have known the applicant:
as an undergraduate
as an undergraduate assistant
as a graduate student
as a teaching assistant
as an advisee
other; please specify
4. The applicant has taken:
none of my classes
one of my classes
two or more of my classes
5. Indicate the population with which the applicant is being compared in this rating:
High school students whom I have taught or known
Undergraduate students whom I have taught or known
Graduate students whom I have taught or known
All students, graduate and undergraduate, whom I have taught or known
Colleagues with whom I have worked
6. Is the applicant's academic potential greater or less than that indicated by his/her grades?
much less
somewhat less
somewhat greater
much greater
equal
cannot determine
If you selected “cannot determine,” please explain/clarify:
7. Global Ratings: Compared to the population in Item 5, rate this applicant on each
characteristic.
Characteristics
Lower Upper Upper Upper
50%
50%
25%
10%
Upper
5%
No basis
for
judgment
Academic Ability
Analytic Ability
Psychology Knowledge
Oral Expression Skills
Written Expression Skills
Research Skills
Carefulness in Work
Emotional Maturity
Independence and Initiative
Professional Commitment
Desire to Achieve
Social Awareness and Concern
Ability to Work with Others
Potential for Success
8. How would you rate the applicant's potential for clinical or counseling work?
Click here and select one from the drop down menu
9. Indicate the strength of your overall endorsement of the applicant.
Click here and select one from the drop down menu
10. The space below is supplied for any additional information you may wish to provide, such as
explanations of any of the global ratings checked. The most important information you can
provide about this applicant is information that is not reflected in the applicant's transcript and
test scores (i.e., work done outside of class and other experiences you believe are related to
success in graduate school). Please attach additional pages if necessary.
Name of Person Completing this Form
Title
Institution or Affiliation
READ THIS: ONLY the reviewer should submit the completed letter of
recommendation. Recommendations received from the applicant will not
be accepted. Completed letters of recommendation should be emailed to
Theresa Young, secretary, Department of Psychology, Washburn
University using the following email address:
theresa.young@washburn.edu