Rev. 12-2009
Recommendation for The Graduate School
Section I (Applicant to complete this section and send form directly to reference respondent)
Applicant’s Name
____________________________________________
Date of Birth: ____/____/_______
First
Middle
Last
In accordance with The Family Education Rights and Privacy Act of 1974, I agree that the recommendation I am requesting will be held in
confidence by officials of Fayetteville State University and I waive any right I may have to examine it. Yes ____ No ____
Applicant’s Signature:______________________________________________ Date:______________________
Section II (To be completed by the Respondent)
Respondent’s Name __________________________________________Title/Position: _______________________
First
Middle
Last
Address ______________________________________________________________________________________
Institution/Organization ________________________________ Daytime Telephone Number ___________________
Section III (To be completed by the Respondent)
EVALUATION:
Using the rating scales shown below, please evaluate the applicant’s characteristics by placing a check in the
column that most nearly represents your opinion of the applicant.
Below
Superior
Inadequate Opportunity
Average
Good
Average
(Top 10%)
to Observe (Unknown)
Ability to master academic work
Oral communication
Written communication
Emotional stability and maturity
Self-reliance and independence
Ability to work with others
Creative or innovative talent
Teaching potential (evaluate if appropriate)
Leadership potential
Analytical skills (Problem recognition, structuring, and
problem solving)
RECOMMENDED WITH:
CONFIDENCE ______
RESERVATION _____
NOT RECOMMENDED _____
COMMENTS:
In the space below, please write any comments which will assist the committee in making a judgment as to whether
the applicant should be admitted to The Graduate School. Please attach an additional sheet if necessary.
How long have you known applicant? ______________ In what connection? ________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Signature of Respondent _______________________________________ Date ___________________________
Respondent should mail this form directly to: The Graduate School
Fayetteville State University
1200 Murchison Road
Fayetteville, NC 28301-4298