Recommendation Form

NOTICE TO APPLICANT:  The recommender is strongly urged to use this form.

Please provide the following information before giving the form to him/her.

Name of Applicant: (please print) ________________________________________
I do ____ do not ____ (check one) waive my right of access to this reference letter.
Signed: __________________________________ Date:_____________________

NOTICE TO RECOMMENDER:  DUE DATE:   Wednesday, January 14, 2009.
As a student in my class(es) this person ranks in the:
Top 10% ___ Top 20% ___ Top 30% ___ Top 50% ___ No opportunity to evaluate ____
As a student clinician this person ranks in the:
Top 10% ___ Top 20% ___ Top 30% ___ Top 50% ___ No opportunity to evaluate ____
This student's ability to work independently is:
Superior ___ Excellent ___ Good ___ Adequate ___ No opportunity to evaluate _____
This student's interpersonal communication skills are:
Superior ___ Excellent ___ Good ___ Adequate ___ No opportunity to evaluate _____

Please check only one of the following categories:
____ A. OUTSTANDING CANDIDATE. Graduate program should actively seek to recruit this student.
____ B. STRONG CANDIDATE. This student is above average and will probably do well.
____ C. ACCEPTABLE CANDIDATE. Guarded optimism. Might need extra support.
____ D. UNACCEPTABLE CANDIDATE. Unlikely to succeed at the graduate level.
____ E. I do not have sufficient data about the student to use one of the above categories (A-D).

Comments: (please use other side if additional space is needed)

Signature of Recommender ________________________________ Date _______________

Name of Recommender (please type or print)______________________________________

Position _____________________________Address _______________________________

Return to:     Coordinator of Graduate Programs
                     School of Communicative Disorders
                     University of Wisconsin-Stevens Point
                     Stevens Point, WI 54481