Reference Form

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Graduate & Professional
S T U D I E S
Reference Form
Please check the appropriate reference field:
Academic
Pastoral
Personal
Professional
TO BE COMPLETED BY APPLICANT
Please give this form to someone who is familiar with your academic work and goals and who is able to comment on your
qualifications as a citizen and as a student for graduate study. This person should not be a family member. Ask the recommender
to complete this form and mail it to Northwest University.
As a courtesy to each reference, please include a stamped envelope addressed to Graduate and Professional Studies Enrollment.
Please type or print.
Graduate program applying for: ____________________________________________
Applicant Name _____________________________________________________________________________________ _
LAST
FIRST
MIDDLE
MAIDEN NAME (IF APPLICABLE)
Street Address _______________________________________________________________________________________
City ____________________________________________ State ___________________ Zip _____________________
I waive my right to review the comments by the person giving the recommendation
I do not waive my right to review the comments
Signature of Applicant ________________________________________________ Date _______ _ _ _ ______________
TO BE COMPLETED BY RECOMMENDER
The person above is applying to a Northwest University graduate program. You have been selected by this applicant to submit your
evaluation of the applicant’s qualifications. Please fill out this form as completely as possible. This information will be held in confidence
and used only for determining the applicant’s qualification for admission. Thank you for your cooperation.
Please type or print.
How long have you known the applicant? ____________________________________________________________ _
In what capacity? ____________________________________________________________________________________
In your opinion, is the applicant qualified for admission to this program?
Yes
No
Undecided
In your opinion, what is the applicant’s relationship with his/her peer group?
Sought out
Admired, but not sought out
Tolerated
Avoided
In your opinion, what are the applicant’s greatest skills or attributes?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
In your opinion, what are the applicant’s greatest weaknesses or difficulties?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
(Continued on reverse side)

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