Confidential Recommendation Form printable pdf download

Confidential Recommendation Form

INSTITUTE FOR GRADUATE CLINICAL PSYCHOLOGY

CONFIDENTIAL RECOMMENDATION FORM

I ⁯ have ⁯ have not waived access to this recommendation.

Student Signature_______________________________________________ Date________________________

: You MUST complete items 1 through 7 on this form. Please type or print.

TO THE APPLICANT

1. Name of applicant:________________________________________________________________________

2. Degree desired (Check one): ⁯PsyD

⁯PsyD/JD

3. Deadline for returning recommendation to the Applicant for inclusion in application packet:_____________

4. Name of Recommender:___________________________________________________________________

5. Position:________________________________________________________________________________

6. Address:________________________________________________________________________________

7. Telephone:______________________________________________________________________________

: When you have completed and signed this recommendation form, place it

TO THE RECOMMENDER

in the envelope provided by the student, seal the envelope, sign your name across the flap, and return the

recommendation to the applicant for inclusion in the application packet. The applicant must include all

recommendation with his/her application. We appreciate your evaluation of the applicant.

A. For how long and in what capacity have you known the applicant?

B. Does the applicant have the necessary attributes in scholarship and character worthy of undertaking

graduate studies? Please explain.

Confidential Recommendation Form