STUDENT STAFF REFERENCE FORM
Department of Residential Life
Minnesota State University, Mankato
Directions: Candidates should complete Section One of this form before giving it to the individual who will complete the reference.
SECTION ONE—To be completed by the Candidate
Candidate's Name (Please include first, middle, and last name):
The Minnesota Data Privacy Act allows a student the right to see their personnel records unless they waive that right. Electing a
waiver relinquishes the student's right to inspect their recommendation. If you would like to review the reference please contact the
Department of Residential Life.
Please choose one of the following and then sign:
I wish to have the right to review this reference.
I waive my right to review this reference.
Candidate's Electronic Signature:
Date:
SECTION TWO—To be completed by the Reference
COMMUNITY ADVISORS
A Community Advisor (CA) is a student employee trained to assist residents in both their transition and ongoing success to residence
hall living and college life. CAs are responsible for tasks which include social, recreational and educational programming; peer
counseling, and maintaining an environment conducive to community and academic success.
Directions: For each section, score the applicant’s overall ability based on the rating scale listed below. Any additional
information you are able to provide is welcomed and is particularly useful in assessing the candidate’s skills and abilities. Please
include any additional written comments in the space provided or on a separate sheet.
E = Excellent
LEADERSHIP
G = Good
S = Satisfactory
B = Below Average
E
G
P = Poor
S
NO = Not Observed
B
P
NO
Influences and guides groups and individuals positively  Demonstrates appropriate use of authority and direction 
Is an effective follower  Has performed in "formal" leadership roles
If known, please list examples:
INITIATIVE
E
G
S
B
P
NO
Is a self-starter, completes tasks before being asked  Seeks opportunities to contribute to group/organization 
Can work independently with minimal supervision
If known, please list examples:
RELATABILITY
E
G
S
B
P
NO
Displays friendliness, honesty, tact, adaptability, patience, sense of humor, appropriate self confidence, approachability, sensitivity,
warmth, open-mindedness
Describe specific traits:
MATURITY
E
G
S
B
P
NO
Able to deal with confidential material in interpersonal situations  Handles stress appropriately Demonstrates Self Awareness
If known, please list examples:
COMMUNICATION SKILLS
E
G
S
B
P
NO
Expresses self well verbally and in writing  Organizes ideas and communicates effectively with others  Formulates ideas before
speaking, easily understood and sincere  Uses congruent body language and appropriate eye contact
Describe applicant's communication style with others:
COOPERATIVENESS
E
G
S
B
P
NO
Works effectively with many types of people  Appropriately confronts issues of concern to colleagues or supervisor(s)
 Demonstrates a willingness to compromise/negotiate with co-workers  Displays a positive attitude about accomplishing tasks
and working with others  Is a "team player"; has demonstrated the ability to collaborate with others
If known, please list examples:
ADMINISTRATIVE ABILITY/RESPONSIBILITY
E
G
S
B
P
NO
Handles administrative tasks well  Effective time manager  Is prompt and can prioritize tasks effectively  Appropriate attention to
details  Accomplishes tasks promptly and effectively  Takes appropriate ownership for their actions  Follows through on
commitments
If known, please list examples:
How well do you know the candidate, how long, and in what capacity?
Additional Comments:
Your Recommendation:
Recommend
Your Name
Position Title
Telephone
THANK YOU!
Your input is a valued part of our CA
selection processes.
Recommend with Reservation(s)
Do NOT Recommend
Please return this form by November 10th to:
By email: matthew.burns@mnsu.edu
or by mail:
Matt Burns
Department of Residential Life
Minnesota State University, Mankato
111 Carkoski Commons
Mankato, Minnesota 56001
Telephone: 507-389-5633
Fax: 507-389-2687