Health Education Reference Form for Graduate Application
Please complete this recommendation by the 3rd Friday in January for summer or fall semester and September 1 for spring semester

Indicate the program to which the student is seeking admission:
MS in Education
Master in Public Health
PhD

 
Applicant Last Name:
Applicant First Name:
   
Person Completing this Form:  
Last Name:
First Name
Title
Institution/Agency
Address
City
State
Zip
Phone
Fax
Date
Email:  
Note, after receiving your assessment, you will be sent a follow-up email to confirm your comments.
 

PART I: Please rate the applicant in each of the areas listed below in comparison with either other graduate students you have known or other health education professionals with equivalent experience.
 
Attribute

Truly Outstanding

(Top 5%)

Excellent

(Top 10%)

Above Average

(Top 25%)

Below Average

(Lower 50%)

No basis for judgment

Capacity for clear oral expression

Capacity for clear written expression

Ability to plan and conduct research

Ability to work independently

Ability to work cooperatively with others
Intellectual curiosity
Intellectual ability
Initiative & motivation
Creativity & originality
Ability to think critically
Time management skills
Organizational skills
Attribute Truly Outstanding

(Top 5%)

 Excellent

(Top 10%)

 		Above Average

(Top 25%)

 		Below Average

(Lower 50%)

 		No basis for judgment
Ability to perform graduate level course work
Leadership potential

Analytical ability

Openness to change

Self-confidence

Teaching potential

Dependability; reliability; resourcefulness

Overall potential for graduate work

 

PART II: Please add any comments that would assist us in evaluating the applicant’s potential for graduate studies in health education. Your remarks will be most helpful if they go beyond general endorsement and help in distinguishing this applicant from others. This section is very important. 

Please focus on specific strengths or weaknesses in areas such as:

PART III: OVERALL RECOMMENDATION:

I strongly recommend the applicant.
I recommend the applicant with some reservation.
I have substantial doubts about the applicant but think s/he should be given a chance to prove her/himself.
I cannot recommend the applicant for graduate education.

Any other comments?