Applicant Reference Form - Missouri State University

Master of Science in Student Affairs
Missouri State University
Applicant Reference Form
For use in the selection of students for the Master of Science degree program in Student Affairs at
Missouri State University.
Applicant Name (Type or Print)____________________________________________________________
Under the federal Family Educational Rights and Privacy Act of 1974, students are entitled to review
their academic 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. It is the applicant’s option to waive his/her right to access
these recommendations or to decline to do so. Please mark the appropriate phrase below, indicating
your choice of options, and sign before giving to the person completing the recommendation form.
______ I waive my right to have access to review this recommendation.
______ I do not waive my right to have access to review this recommendation.
Applicant signature:___________________________________________ Date:_____________________
To the recommender:
How well do you know the applicant? _____Casually _____Somewhat _____Well _____Very Well
In what capacity have you known this applicant? _____________________________________________
How long? ____________________________________________________________________________
Please rate the applicant on each of the following in comparison with others you have known in similar
capacities (Circle a number for each item).
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Academic intellectual abilities:
Interpersonal relationship skills:
Emotional maturity:
Psychological self-awareness:
Writing skills:
Professional commitment:
Initiative:
Ability to work with colleagues:
Potential as a principal:
Creativity:
Open mindedness:
Overall qualifications for graduate study:
Poor
1
1
1
1
1
1
1
1
1
1
1
1
2
2
2
2
2
2
2
2
2
2
2
2
Average
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
3
4
Superior
5
5
5
5
5
5
5
5
5
5
5
5
No Basis
N
N
N
N
N
N
N
N
N
N
N
N
Please provide any written comments about this applicant you would like to add to your ratings above. If
you would prefer, you are welcome to attach a separate letter as well. Thank you for your contribution
to this process.
_______________________________
Signature of Recommender
____________________________________
Typed/Printed Name of Recommender
_______________________________
Position
____________
Date
Mail to:
Master of Science in Student Affairs program
Missouri State University
901 South National Avenue
Springfield, MO 65897
___________________
Telephone