Personal Reference For Graduate Study
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1Personal Reference For Graduate Study
To The Applicant
This section to be completed by the Applicant.
Name ____________________________________________________________
Home Phone (
) _____________________
Last (family/legal name)
First (given name)
Cell Phone (
) _______________ Daytime Phone (
) ________________ E-mail _________________________________
Graduate Program __________________________________________________
Waiver: Sign one of the two statements before giving this form to the person recommending you.
1. I understand that the amended Family Educational Rights and Privacy Act provides that the applicant may waive the right to inspect
letters of recommendation respecting admission to any educational agency or institution. I herby waive this right, thus electing to es-
tablish a confidential graduate admissions file with Notre Dame de Namur University. I further understand that confidential letters of
recommendation will be withheld from me. If I withdraw or revoke this waiver, confidential letters in my file will be withdrawn for
return to the writer, and I will not be permitted to inspect them.
Signature ____________________________
Print Name _______________________________
Date ____________________
2. I elect to establish a non-confidential (open) graduate admission file with Notre Dame de Namur University. Persons from whom
letters of recommendation are solicited will understand that I may have access to them.
Signature ____________________________
Print Name _______________________________
Date ____________________
To The Recommender
The person named above is an applicant for admissions to a graduate program at Notre Dame de Namur University. To evaluate the applicant, please
answer the following points. We appreciate your insights and participation in the process.
1. How long and in what capacity have you known the applicant? _______________________________________________________
____________________________________________________________________________________________________________
2. Please indicate the strengths and weaknesses of the applicant:
Above Average Average
Below Average
No Chance to Observe
A. Initiative
B. Academic Ability
C. Leadership Qualities
D. Integrity
E. Potential in Intended Field Career
3. Based on my observation, this applicant has my:
Strongest recommendation
Recommendation
Recommendation w/ reservation
Limited endorsement
4. Please provide a statement about the applicant’s qualifications and suitability for the intended graduate program.
Signature _________________________________________ Title ____________________________________ Date _____________________
Print Name _______________________________________ Organization ______________________________
Phone ____________________________________________ Email Address _____________________________
Please complete and send this reference to: Notre Dame de Namur University
Office of Graduate Admissions
1500 Ralston Avenue
Belmont, CA 94002-1908
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Parent category: Letters