Admissions Recommendation Form
Office of Admissions
600 Lincoln Ave. Charleston, IL 61920. (217) 581‐2223 office (217) 581‐7060 fax
1. Name of Student (print):
Date of birth :
:
To the Evaluator
Please rate the candidate on the following characteristics and answer the questions.
Personal comments can be typed or handwritten in the space below. This evaluation will become part of the
student’s admissions file. Please return or fax the completed reference form directly to the Office of
Admissions at the above address. We may contact you for further information.
Above
Unable to
Characteristic
Excellent
Average
Poor
Average
Rate
Academic Ability
Attitude
Initiative
Oral Communication
Potential for Success
Problem Solving
Reading Comprehension
Quality of Writing
How long have you known the student? year(s) month(s)
In what capacity (teacher, counselor, etc.) do you know the student?
Subject:
How well do you know the student? Very Well Fairly Well Casually Unable to Rate
Would you please address this student’s academic preparedness/motivation to be successful in college:
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Signature of person completing form:
Date:
Name (print):
Position/Title:
Institution/Affiliation name:
Email address: ______________________ _____________ Phone #: ____________________
The Family Educational Rights & Privacy Act of 1974 opens many records for the student’s inspection. The Law also permits the student to sign a waiver relinquishing
personal rights to inspect letters of recommendation. Call to determine if this candidate has waived their right to view this recommendation form.