Department of Social Work MSW Application Forms Academic Year

Transcription

1 Department of Social Work MSW Application Forms Academic Year FOR SPRING 2016 ADMISSION, SUBMIT YOUR APPLICATION ON OR BEFORE OCTOBER 15, 2015, TO BE GUARANTEED FULL CONSIDERATION FOR SUMMER/FALL 2016 ADMISSION, SUBMIT YOUR APPLICATION ON OR BEFORE JANUARY 15, 2016, TO BE GUARANTEED FULL CONSIDERATION 1. As the FIRST STEP in your application process, in addition to this application, you (including those who are currently attending Washburn University) must also file an online degree-seeking Master s degree application to the Washburn University Admissions office for the semester in which you intend to start your graduate program. Doing this early will expedite the process. 2. The SECOND STEP is completing and submitting this MSW Application Packet. INTERNATIONAL STUDENTS: Please see requirements on page 10 of this application. Please submit all pages of this application in single sided format, no staples. Before mailing or delivering your packet (a large envelope containing all required documents) to us, make sure it is complete. Verify that you have included/completed: Washburn University Online Application (see bottom of p. 2). A cover letter of introduction. This is every applicant s obligation in keeping with academic/professional standards. If any of the following apply to you, please address these issues in your cover letter. The awarding of your undergraduate degree is pending (and the expected date of its completion) Completion of your BSW practicum is pending (and the expected date of its completion) You have taken social work classes at Washburn University in the past A check or money order to cover the $25 application fee (see p. 3), and an MSW Application (see pp. 3 and 6 11). We recommend you photocopy your completed MSW Application before you place it in your packet, and keep the copy for your personal records. Your four-page personal statement with detailed responses to Parts A, B, and C, along with your one- or two-page resume (see p. 3). Your three references. Each reference set should be in a sealed envelope with the evaluator s signature across the flap (see pp. 3, 4, 11-16). If you are applying for Advanced Standing, you must meet additional requirements (see pp. 3-5). If you are currently completing your practicum, see pp. 3 and 5. Official transcript from the university from which you received your undergraduate degree, if other than Washburn University. The official transcript should be in a sealed envelope with the university s seal across the flap. Do not send transcripts to the Washburn University Registrar (see p. 4 Item 7 and footnote). 1

2 Washburn University DEPARTMENT OF SOCIAL WORK 1700 College Avenue, Benton Hall, Room 412, Topeka, Kansas (785) Dear MSW Applicant: We appreciate your interest in our Master of Social Work (MSW) program. We hope the information we have provided will assist you in making choices about your graduate education. Go to the Social Work department website ( At the top of the left column, click on Degree Programs-BSW, MSW and then the Master of Social Work (MSW) link. On the Master of Social Work page you will see links to the MSW Student Handbook, as well as this MSW Application Form document. The MSW Student Handbook contains detailed information that will help you understand the policies, application procedures, and other information pertinent to the MSW course of study. APPLICATION REQUIREMENTS Refer to the MSW Student Handbook for a detailed explanation of our application requirements. Persons not fully meeting published admission requirements are encouraged to contact the Social Work Department for assistance. Basic requirements include: 1. A bachelor's degree with a liberal arts foundation, including courses in the social and behavioral sciences 2. Undergraduate coursework in cultural diversity 3. A cumulative grade point average of a 3.0 or better on a 4.0 scale 4. Three reference forms completed by individuals who can objectively assess your potential as a clinical social worker 5. A Personal Statement (see number 4 below for specific instructions) PROGRAM CHOICES 1. Advanced Standing: Applicants who have received a BSW degree from a social work program accredited by the Council on Social Work Education (CSWE) are eligible for the Advanced Standing Program. 2. Regular Standing: This program is for all applicants who have received a bachelor's degree in any discipline other than social work. It is our desire that the application process be a welcoming and user-friendly process for you. We will be happy to answer any of your questions. You can reach us at (785) or social-work@washburn.edu. CHECKLIST AND INSTRUCTIONS FOR ASSEMBLING YOUR MSW APPLICATION 1. Online Application for Washburn University Admission: Everyone who is applying to the program, even if he or she is currently attending Washburn University, must complete an online DEGREE SEEKING MASTERS application to Washburn University. This should be the FIRST STEP in your application process, but please note acceptance to Washburn University does not guarantee admission to the MSW program. Access Click Future Students APPLY NOW Click First time user account creation and create a Login ID and PIN (Example: Login ID = kcaj PIN = ) Choose Degree Seeking-Masters and click Continue. 2

3 2. Application Fee: A check or money order made payable to Washburn University for $25 must be included in your packet along with your completed application. This $25 fee is non-refundable. 3. MSW Application: Regular Standing Applicants: Complete pp. 6 8 Advanced Standing Applicants: Complete pp. 6 9 All Applicants: Complete p. 11 Please respond to all items. Write N/A (not applicable) in spaces that do not apply to you. Feel free to use additional pages if more space is needed and make sure your name and the item number appear on that page. Make sure you initial each attestation item (p. 11) and sign/date both pp. 7 and 11. Please place all these completed pages (single-sided only, no staples) in your packet along with your other required application documents. 4. Personal Statement: The Personal Statement must be typed, double-spaced, and approximately four pages long (single-sided, no staples). Social work is a profession concerned with personal growth and social change. So that the Admissions Committee can accurately assess your abilities, it must have your written comments which address several issues. Please respond, in detail, to each discussion topic (A C) listed below: A. Discuss the development of your interest in social work and social welfare. Explain why you have chosen to pursue a clinical MSW degree, and identify your career goals and plans following completion of professional social work training at Washburn University. B. Identify and describe your personal assets and areas of weakness that you bring to the Department of Social Work. The strengths and weaknesses you discuss should be relevant to your professional education, training, and future performance as a social worker. C. Discuss, at length, the Code of Ethics of the National Association of Social Workers (NASW) and describe how the code is compatible or incompatible with your personal values and worldview. The Code of Ethics of NASW can be found on the Internet at: When you have comprehensively addressed items A, B, and C, place the document in your packet along with all your other completed application items. 5. Resume: You must submit a carefully prepared, professional quality 1-2 page resume summarizing pertinent educational, employment, volunteer, and community service experience. Begin with your present position; include any paid employment with the military, VISTA, Peace Corps, etc. Add your resume to the other materials in your packet. 6. References (pp ): Choose three individuals who have recent, extensive knowledge of your qualifications for graduate study in social work. These references should be able to provide valid information on your academic abilities, commitment to social work values and ethics, emotional stability and maturity, and readiness to enter the graduate program in preparation for a career in clinical social work. If you are currently completing, or have completed a field practicum or internship within the past few years (or are currently employed or have previous experience as a social worker), one letter must be completed by your field instructor/supervisor. If you recently started your field practicum and your field instructor does not yet know you well enough to provide a reference, choose three individuals who have recent, extensive knowledge of your qualifications for graduate study in social work. Other references might include a professor, an employer, a manager, etc. References should not come from family or 3

4 friends; the greatest weight will be given to references from current and former supervisors, faculty, or experienced social workers and social service professionals as opposed to co-workers. Less weight will be given to references from professionals with limited experience, or from work and school peers. ZDOZ XDO NOT X Make sure you check one of the boxes! It is your right under The Family Educational Rights and Privacy Act (see pp. 11, 13, 15). Before sending forms to the people who will provide your references, read and complete the first page of each reference form. Either waive or claim your right to inspect an evaluator s commentary (after the Reference Statement has been submitted UNOPENED to the Social Work Department) by checking the appropriate box on the first page of each reference form, and sign and date it. Give each of your three evaluators the first and second pages of the reference form and a self-addressed, stamped envelope. Make sure each person understands he or she MUST FULLY COMPLETE items 1 through 5 on the second page of the reference sheet. Request that he/she enclose both pages of the completed reference (the page you complete plus the page/s he/she completes) in the envelope, seal it, sign across the flap, and then return the envelope to YOU. Do not break the seal; we will not consider reference letters that have been opened. When ALL THREE reference letters are returned to you, place the unopened references in your packet along with your completed application and all other documents. Be certain that every reference form is sent directly to you; then, gather your three references together with the other required material, and mail or deliver the entire packet to the Washburn University Department of Social Work. Any reference form that is sent directly to us by the person completing a reference will be returned to him/her. Items 1-5 on the reference sheet must be fully completed by your evaluator or the form will be returned to him/her. 7. Transcripts: Please include the official transcript for the college or university from which you received your bachelor s degree. Unofficial transcripts or copies of transcripts will not be accepted. The official transcript must be received in our office before we will review your application. Place the unopened transcript in your packet along with your completed application and all other documents. 1 Do not send your transcript to the Washburn University Admissions Office or the University Registrar. Please send it to the Social Work Department in your completed application packet. 8. Additional Requirements if you are seeking Advanced Standing status: If you are an Advanced Standing applicant you must also provide the following: A letter of reference (one of your three) from the field instructor who supervised you during your BSW social work practicum placement. This letter must speak to the successful completion of your practicum, and should also address your fitness for Advanced Standing status. The letter should include an assessment of your potential to develop into a competent and effective clinical social worker. Your final undergraduate social work field practicum evaluation signed by your field instructor. 1 If Washburn University is your last or current university of attendance and all your transcripts are on file with the Washburn Registrar, you do not need to submit any transcripts; just mention in your cover letter the fact that Washburn is your last school of attendance and that all your transcripts are on file with the Registrar. 4

5 Advanced Standing status will not be considered unless you include a reference letter from your field instructor and a copy of your final field practicum evaluation which has been signed by your field instructor. If you are in the process of completing a practicum and a letter from your field instructor is not available, an appropriate, alternative reference may be submitted; however, you must submit your final field evaluation when it becomes available. If you have questions concerning field practicum evaluations, contact Steve Spyres, steve.spyres@washburn.edu phone: or Application Timeline: We have two application timeframes. The first deadline each year is January 15. If accepted for this cycle, you may start the next summer or fall semester. The second deadline is October 15. If accepted for this cycle, you may start the following spring semester. Application deadlines extend to the next Washburn University business day if January 15 th or October 15 th falls on a weekend or holiday. Timely submission guarantees full consideration. Late applicants should contact the MSW Program Director and request permission to apply after a deadline. Failure to complete the application procedure in its entirety may significantly delay the processing of your application. It is your responsibility to follow up with the Social Work Department, in a timely manner, to make sure your application is complete. If you are admitted to the program, any falsification or misrepresentation of information in your application may be cause for rejection of the application or immediate dismissal from the program upon later discovery of the falsification. 10. Delivery of the Application: Mail or hand-deliver your completed application packet to: Attn: MSW Admissions, Washburn University Department of Social Work, Benton Hall, Room 412, 1700 S.W. College Avenue, Topeka, Kansas Finally, it is your responsibility to make sure that all application materials (cover letter; MSW application with attestation, personal statement and resume; three references; and undergraduate transcript, plus any additional required documents) are enclosed in one envelope as a single packet. It is to your advantage to fully complete all electronic and paper applications and to submit them as early as possible. Applications are often evaluated by the Admissions Committee in the order they are received. Please note: Applicants who are not admitted to the MSW Program will not receive specific information about the reasons for such a decision. If you have questions, please contact the Social Work office at or at socialwork@washburn.edu. Please note that decisions regarding admissions take at least six to eight weeks following the application deadline. Thank you for your interest in our program! Sincerely, Bassima Schbley, PhD, LMSW MSW Program Director 5

6 WASHBURN UNIVERSITY DEPARTMENT OF SOCIAL WORK 1700 SW College Avenue, Benton Hall, Room 412, Topeka, Kansas (785) Application for Admission to the Masters Program *PLEASE PRINT THIS INFORMATION LEGIBLY* Date: Name: (Last) (First) (Middle) Daytime Phone #: ( ) Home / Cell # Phone Circle Home #: or Cell ( ) Current Mailing Address: (Street) (City) (State) (Zip Code) Country of Citizenship: *Optional: Birth Date*: Gender*: F M Month Day Year Standing for which you are applying (check one): Regular Standing (non-bsw degree required) Advanced Standing (BSW degree required) Your starting semester. This must match your choice when you applied online for admission to Washburn University (check one): Spring 2016 Summer 2016 Fall 2016 Status for which you are applying (check one): Full-Time Part-Time I have taken social work courses at Washburn University or at another university (check all that apply): As an undergraduate As a non-matriculating graduate student As a matriculating graduate student Concurrent employment while attending the MSW Program (check one): I plan to work Full-Time Part-Time -- or -- I will not be employed while attending the MSW Program at Washburn University. Special interests (check any that apply): Dual JD-MSW Degree School Social Work Concentration Other interests (please specify): 6

7 Academic History: List, in order of attendance, all Colleges and Universities you have attended (starting with the most recent program). Your application will not be processed unless your BA degree transcript is enclosed. Please provide any other name(s) (i.e. maiden name) that may appear on official transcripts: Name of College/University Location (City, State) Dates Attended Mo/Yr Mo/Yr Major BA Degree Date Received Cumulative GPA List the names of persons from whom you have requested references: Name of Reference Position Held/Agency Name Relationship I hereby certify that the answers and statements contained in this application are true to the best of my knowledge/belief. Signature Date 7

8 Liberal Arts Requirements (for ALL Applicants) Consistent with the importance ascribed an undergraduate liberal arts coursework foundation by the Council on Social Work Education (CSWE) and Washburn University, there should be evidence of this type of adequate preparation to begin graduate study. Such preparation must include satisfactory completion (i.e., at least a C ) of undergraduate coursework in each of the following areas: the natural sciences, social sciences, humanities, English composition, and mathematics. There must also be evidence of satisfactory completion of coursework in cultural diversity content. Students who lack coursework in any of these areas may be required to complete undergraduate courses during their first year of admission to the graduate program. Given these general guidelines, please review your undergraduate transcript(s) and note in the table below which courses meet the requirements for each content area. You need not list any more than two or three courses for each area. Simply put the course information in the empty box to the right of each content area. Please list (a) the course, (b) the corresponding semester in which you took the course (in parentheses), and (c) the grade you received for the course. For example, if you took Cultural Anthropology at Washburn University in the Fall Semester of 2014 and earned a B, then you would list it in the box to the right of the Cultural Diversity Content item as AN 112 (Fall 2014) - B. English Composition (list just 2 courses) Mathematics (list 1-2 courses) Social Sciences (list 2-3 courses) Humanities (list 2-3 courses) Natural Sciences (list 2-3 courses) Cultural Diversity Content (list 1-2 courses) 8

9 Advanced Standing Applicants Only: Please refer to your transcript and fill in, as best as you can, the social work courses you completed that you believe are equivalent to the Washburn University social work courses listed below. See the MSW Student Handbook (link is at ) for course descriptions. A final determination will be made by the MSW Director. Admission into the MSW Program at Washburn University will be contingent upon completion of coursework and/or other requirements prescribed by the Admissions Committee. An applicant cannot begin taking courses in the MSW Program at Washburn University until he/she has earned a baccalaureate degree at an accredited university in a CSWE-accredited program. Student Name: University/College: Course # Washburn University Course WU Hours Equivalent Course Equivalent Hours Grade SW 606 Micro HBSE 3 SW 607 Macro HBSE 3 SW 608 Foundations of Social Policy 3 SW 609 Social Policy and Advocacy 3 SW 621 Quantitative Social Work Research 3 SW 622 Qualitative Social Work Research 3 SW 640 Fundamentals of Social Work Practice 3 SW 691 Generalist Practicum I 5 SW 692 Generalist Practice Seminar I 3 SW 693 Generalist Practicum II 3 SW 694 Generalist Practice Seminar II 3 9

10 MSW ADMISSIONS -- INTERNATIONAL STUDENTS International students applying to the Washburn MSW program must: Already have a university credential that is equivalent to a US bachelor s degree. Satisfy the admission requirements for the Washburn University MSW program. Among the requirements is a minimum undergraduate grade point average of 3.0 on a 4.0 scale, three professional letters of reference, transcripts, narrative statement, resume, and $25 application fee. Submit the required international application and other required materials to the Office of International Programs. The international application fee is $70 US (Note: This fee is separate from the $25 MSW application fee). Have transcripts from any non-us institutions evaluated by a recognized evaluation service at the applicant s expense -- from either Educational Credential Evaluators or from the World Education Services -- and submitted to the Office of International Programs. Provide evidence of having taken the Test of English as a Foreign Language (TOEFL) examination within the past two years. Minimum TOEFL scores required for admission to the MSW program are as follows: Listening (25), Reading (23), Speaking (24), Writing (24). Students without a score or with a low score should seek admission to the Intensive English Program. Native speakers of English or students who have earned a four-year degree from a US college or university are exempt from these requirements. Contact the Office of International Programs with any questions regarding the university s application process, English language proficiency requirement or immigration-related inquiries. The need to take English courses may delay an applicant s start in or extend the length of the MSW program. Approved by SW Faculty effective

11 MSW Program Attestation Form Please refer to the MSW Student Handbook (at ) to review each attestation item listed below. Once you have read the item section in the Handbook and understand it, please initial the line to the left of the item category. After you have read and initialed all the items noted in the Handbook, please sign and date the bottom of this form and return this page as part of your MSW application packet. Initial Item Page # MSW Mission Statement (p. 5) MSW Program Goals and Objectives (pp. 6-7) Four Year Completion of Program Requirement (p. 11) Online New MSW Student Orientation (p. 12) Sequence of Coursework (pp ) Registration/Enrollment (p. 23) Academic Advising and Student Development (p. 23) Academic Advising Guidelines for Social Work Students (pp ) Application for Graduation (p. 25) Practica and Seminars (pp ) The Practicum Experience (pp ) Additional Practicum Policies (pp ) Practicum Hours (p. 33) Affirmative Action Policy (p. 35) Disability Services (p. 35) Washburn University Graduate Social Work Association (p. 36) Academic Integrity and Honesty (p. 36) Courtesy Expectations (p. 36) Confidentiality (p. 37) NASW Code of Ethics (p. 37) Desire2Learn (D2L) Training (p. 37) Attendance and Class Participation (p. 37) Writing and the APA Style (p. 38) Communications and Official Address (p. 38) icard (p. 38) Instructor/Course Evaluation (p. 39) Social Work Department Program Evaluations (p. 40) Grading Policies (pp ) Academic Probation (p. 42) Incomplete Grade (p. 42) Course Withdrawal (p. 42) Withdrawal from the Program (p. 42) Grade Appeal Procedures (p. 43) Academic Dismissal Procedures (p. 43) Appeal of Academic Dismissal (p. 43) I (the undersigned) have read and understand all the items listed above and agree to all stipulations contained therein. I acknowledge that failure to comply with these expectations may result in suspension in and/or dismissal from my academic program at Washburn University. Printed Name Student Signature WIN Date 11

12 WASHBURN UNIVERSITY DEPARTMENT OF SOCIAL WORK 1700 SW College Avenue, Benton Hall, Room 412, Topeka, Kansas Reference Statement Applicant completes this box. Please print your name: The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right to access references. The choice of the applicant regarding this reference is to be indicated below: (Check one) I DO DO NOT waive my right to inspect the contents of the following reference. Please request a reference statement from three persons who have extensive knowledge of your qualifications for graduate study in social work. Re-read the instructions regarding references to make sure you fully understand how to complete this reference form. INSTRUCTIONS FOR THE PERSON SERVING AS A REFERENCE FOR THE ABOVE-NAMED APPLICANT To the Reference (Evaluator): The above-named person is applying for admission to the MSW Program at Washburn University, and has given your name as a reference. We seek students who demonstrate potential for graduate academic work as well as commitment to the welfare of all. Our program originates from the historical roots of social work. It is inextricably linked with the core values of the profession, including the ongoing pursuit of social and economic justice, the value, worth and dignity of all persons, the belief in client determination, and the potential for growth. Please give us a candid assessment of this applicant regarding his/her suitability for our program. You may attach a separate letter with this form, if you prefer; however, the form MUST be completed in its entirety. Please give (or mail) this 2-page form to the applicant in a sealed envelope, after you sign across the flap. The applicant will then include this reference form in her/his application packet. Please submit all pages of your reference in single-sided format, no staples. 12

13 1. How long and in what capacity have you known the applicant? Months/Years Nature of Relationship (employer, co-worker, supervisor, etc.) 2. Please comment on any specific talents demonstrated in working with people, completing tasks, dependability and other work related skills. 3. What is your estimate of the applicant's promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, and capability for self-reflection.) 4. Please indicate the applicant's ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. Intellectual capacity Self-reliance, motivation Ability to deal with stress Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Superior Excellent Very Good Average Below Avg. Unable to Rank 5. I would: Highly Recommend Recommend Recommend with reservation Signature: Name (Print or Type): Organization: Date: Title: Address: Phone: 13

14 Applicant completes this box. Please print your name: WASHBURN UNIVERSITY DEPARTMENT OF SOCIAL WORK 1700 SW College Avenue, Benton Hall, Room 412, Topeka, Kansas Reference Statement The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right to access references. The choice of the applicant regarding this reference is to be indicated below: (Check one) I DO DO NOT waive my right to inspect the contents of the following reference. Please request a reference statement from three persons who have extensive knowledge of your qualifications for graduate study in social work. Re-read the instructions regarding references to make sure you fully understand how to complete this reference form. INSTRUCTIONS FOR THE PERSON SERVING AS A REFERENCE FOR THE ABOVE-NAMED APPLICANT To the Reference (Evaluator): The above-named person is applying for admission to the MSW Program at Washburn University, and has given your name as a reference. We seek students who demonstrate potential for graduate academic work as well as commitment to the welfare of all. Our program originates from the historical roots of social work. It is inextricably linked with the core values of the profession, including the ongoing pursuit of social and economic justice, the value, worth and dignity of all persons, the belief in client determination, and the potential for growth. Please give us a candid assessment of this applicant regarding his/her suitability for our program. You may attach a separate letter with this form, if you prefer; however, the form MUST be completed in its entirety. Please give (or mail) this 2-page form to the applicant in a sealed envelope, after you sign across the flap. The applicant will then include this reference form in her/his application packet. Please submit all pages of your reference in single-sided format, no staples. 14

15 1. How long and in what capacity have you known the applicant? Months/Years Nature of Relationship (employer, co-worker, supervisor, etc.) 2. Please comment on any specific talents demonstrated in working with people, completing tasks, dependability and other work related skills. 3. What is your estimate of the applicant's promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, and capability for self-reflection.) 4. Please indicate the applicant's ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. Intellectual capacity Self-reliance, motivation Ability to deal with stress Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Superior Excellent Very Good Average Below Avg. Unable to Rank 5. I would: Highly Recommend Recommend Recommend with reservation Signature: Name (Print or Type): Organization: Date: Title: Address: Phone: 15

16 . WASHBURN UNIVERSITY Applicant completes this box. Please print your name: DEPARTMENT OF SOCIAL WORK 1700 SW College Avenue, Benton Hall, Room 412, Topeka, Kansas Reference Statement The Family Educational Rights and Privacy Act and its amendments guarantee students access to their educational records. Students may, however, waive their right to access references. The choice of the applicant regarding this reference is to be indicated below: (Check one) I DO DO NOT waive my right to inspect the contents of the following reference. Please request a reference statement from three persons who have extensive knowledge of your qualifications for graduate study in social work. Re-read the instructions regarding references to make sure you fully understand how to complete this reference form. INSTRUCTIONS FOR THE PERSON SERVING AS A REFERENCE FOR THE ABOVE-NAMED APPLICANT To the Reference (Evaluator): The above-named person is applying for admission to the MSW Program at Washburn University, and has given your name as a reference. We seek students who demonstrate potential for graduate academic work as well as commitment to the welfare of all. Our program originates from the historical roots of social work. It is inextricably linked with the core values of the profession, including the ongoing pursuit of social and economic justice, the value, worth and dignity of all persons, the belief in client determination, and the potential for growth. Please give us a candid assessment of this applicant regarding his/her suitability for our program. You may attach a separate letter with this form, if you prefer; however, the form MUST be completed in its entirety. Please give (or mail) this 2-page form to the applicant in a sealed envelope, after you sign across the flap. The applicant will then include this reference form in her/his application packet. Please submit all pages of your reference in single-sided format, no staples. 16

17 1. How long and in what capacity have you known the applicant? Months/Years Nature of Relationship (employer, co-worker, supervisor, etc.) 2. Please comment on any specific talents demonstrated in working with people, completing tasks, dependability and other work related skills. 3. What is your estimate of the applicant's promise as a graduate student? (Intellectual independence, capacity for analytical thinking, ability to organize and express ideas clearly, scholarly and professional potential, and capability for self-reflection.) 4. Please indicate the applicant's ability and professional competence in comparison to other individuals whom you have known at similar stages in their careers. Intellectual capacity Self-reliance, motivation Ability to deal with stress Emotional stability, maturity Ability to make decisions Writing skills Verbal skills Growth potential Skills in relating to others Cultural sensitivity Superior Excellent Very Good Average Below Avg. Unable to Rank 5. I would: Highly Recommend Recommend Recommend with reservation Signature: Name (Print or Type): Organization: Date: Title: Address: Phone: 17