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Feb
12

Inaugural Integrated Behavioral Health Symposium
Letter of Reference
  1. THIS FORM IS ONLY TO BE USED FOR BSW APPLICANTS ONLY
  2. This form is INTENDED TO BE COMPLETED BY THE REFERRER on behalf of an applicant. Required fields are indicated by (*).
  3. Information about Applicant
  4. Applicant Name(*)
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  5. Information about Referrer
  6. Referrer Name(*)
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  7. Email Address:(*)
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  8. Do you have a Social Work Degree?(*)
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  9. How long have you known the applicant?(*)
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  10. In what capacity have you known the applicant?(*)
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  11. Please rate the applicant. Relate them to other individuals you have known in social work or other human services fields.
  12. Potential to enhance the lives of people(*)
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  13. Commitment to Social Justice(*)
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  14. Ability to work with others.(*)
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  15. Maturity(*)
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  16. Integrity and Honesty(*)
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  17. Leadership Skills(*)
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  18. Sense of Responsibility(*)
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  19. Motivation(*)
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  20. Initiative(*)
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  21. Judgment(*)
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  22. Written Communication Skills(*)
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  23. Verbal Communication Skills(*)
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  24. Overall Academic Potential(*)
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  25. Ability to accept feedback.(*)
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  26. Additional Comments:
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  27. Indicate your "overall" recommendation for this applicant:(*)
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  28. We thank you for your willingness to serve as a reference for this applicant to the BSW Program.
  29. The information on this form is true to the best of my knowledge. Should I furnish any false information on this reference, I understand that this act shall constitute a fraudulent act on which I can be prosecuted to the full extent of the law.
  30. Enter in info(*)
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  31. Agreement(*)
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