Reference Evaluation From

Reference Evaluation From
TO THE EVALUATOR: Please complete the form below for your reference.

The applicant below has chosen you as a reference in support of an application for the Practical Nursing program at Bridgerland Technical College. This is based on the understanding that you have known the applicant for at least six (6) months. We are particularly interested in your appraisal of the applicant's abilities and potential for further education. Please take a few moments to complete this form.

Thank you,

Eric Haskell

Practical Nursing Director
Applicant Name

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Evaluator Name

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Personal Reference Evaluation Form

Instructions: The following questions or statements identify a variety of traits, skills, attitudes, etc. Please indicate the degree to which each quality is characteristic of the candidate you are rating by reading the statement carefully, reading the points on the scale, and choosing the number of your choice on the scale. Please rate each statement independently and avoid a tendency to rate on general impressions. One characteristic might influence the rating of all characteristics. Specific comments in each category are encouraged.
Problem-Solving: Ability to identify and solve problems

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1 is Poor, 5 is Excellent
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Attitude: Outlook projected towards life, school, job, etc.

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1 is Negative, 5 is Positive
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Stress/Anxiety Response: Deals with stressful, anxiety-producing situations

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1 is Poor, 5 is Excellent, calm, effective
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Motivation/Accountability: Extent to which individual applies self and is accountable

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1 is Uninspired/ Blames Others, 5 is Self Starter; motivated; accountable
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Appearance: Extent to which standards of appearance are met

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1 is Untidy, 5 is Well-Groomed
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Health: Extent to which health or physical disability affects performance

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1 is Health problems often interfere, 5 is Health almost never interferes
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Communication Skills: Ability to communicate with peers, coworkers, teachers, etc.

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1 is Poor, 5 is Excellent
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Integrity: Extent to which the candidate displays an ethical code

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Interpersonal Relationships: Ability to cooperate and get along with peers, coworkers, teachers, employees, etc.

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1 is Poor, 5 is Excellent
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In summary, please indicate the degree to which you support this applicant for study in Practical Nursing

I strongly support this applicantI support with reservation. Please indicate your concerns in the comments section below.I do not support this applicant. Please indicate your concerns in the comments section below.
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