Graduate Programs In Nursing Recommendation Form printable pdf download

Graduate proGrams in nursinG

Roush Hall 208

recommendation form

1 South Grove Street

Westerville, OH 43081-2006

614-823-3210 (phone)

614-823-3208 (fax)

grad@otterbein.edu (e-mail)

(web address)

raduaTe

chool

To the Applicant:

This form should be given to two persons who can recommend you for graduate study (one reference from an RN is preferred). At least one rec-

ommendation should be from an employer. If you have been in school within the last five years, the other recommendation should be from a nursing

professor. Otterbein University reserves the right to contact persons providing recommendations and to acknowledge receipt of recommendations.

Please complete items 1, 2 and 3 below. Be sure to review and complete, if appropriate, the section titled “Applicant’s Waiver of

Right to Access.” Deliver or mail this form to the person who will write the recommendations for you. You should provide each rec-

ommender with a stamped envelope addressed to:

The Graduate School

1 South Grove Street

Otterbein University

Westerville, Ohio 43081-2006

1. Candidate’s Name:

Last

First

Middle

2. Please check area of study:

Master of Science in Nursing (select specialization)

Post Masters in Nursing (select specialization)

❏ Family Nurse Practitioner

❏ Post Masters Family Nurse Practitioner

❏ Clinical Nurse Leader

❏ Post Masters Advanced Practice Nurse Educator Program

❏ Nurse Anesthesia

❏ Post Masters Nurse Anesthesia

Please specify your relationship to the individual who is completing this form. In the case of a faculty person, list the course(s)

you took under the direction of this person.

Course Number

Course Title

Where Taken

Grade

APPLICANT’S WAIVER OF RIGHT TO ACCESS

The Family Educational Rights and Privacy Act of 1974, as amended (P.L. 83-380), allows a candidate for admission, employment, or receipt of honors

to waive his or her right of access to confidential letters or statement written in his or her behalf if the recommendation is used solely for the purposes of

admission, employment, or the receipt of honors and if the candidate, upon request, is notified of the names of all persons making such recommendations

on his or her behalf. The University does not require that you make such a waiver as a condition for admission. However, under the legislation you have

the option of signing such a waiver as follows:

I hereby waive my right of access to this recommendation and any appropriate attachments which have been written by ______________________

________________________ (name of recommender), in behalf of my application for admission to Graduate Studies in Nursing at Otterbein University,

insofar as the recommendation is used solely for the purpose of admission.

Name _______________________________________________________________________________ Date ____________________________

Signature ____________________________________________________________________________________________