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St. Cloud State
University
Department of Social Work
Recommendation Form for Application to Major
Academic Reference
To be completed by the applicant:
Applicant’s Name__________________________
Address:__________________________________
___________________________________
I authorize ______________________________ to complete this
recommendation with the understanding that the information will
be kept confidential.
I do do not waive my right to see the completed form.
(circle one)
************************************
TO THE RESPONDENT:
The above named person is applying for admission to the Social
Work Major at St. Cloud State University. As part of the admission
process, the applicant is requesting a reference from you. We
take seriously your input into this process and appreciate your
taking time to complete this reference form.
Mission Statement
The mission of the Department of Social Work at St. Cloud State
University
is to engage students in an educational process
that prepares them to think critically, and work effectively
and
collaboratively as generalist social workers.
Knowledge of Applicant
1. Approximately how long have you known the
applicant?______________
2. How well do you know the applicant?
___casually
___well
___very well
3. What was the nature of your contacts with the
applicant?
__________________________________________
__________________________________________
__________________________________________
Please rate the following:
Overall Intellectual Excellent Good Adequate Poor
Ability
(4) (3) (2) (1)
Writing Ability (4) (3) (2) (1)
Oral Expression (4) (3) (2) (1)
Analytical Ability (4) (3) (2) (1)
Commitment to Learning (4) (3) (2) (1)
Creativity (4) (3) (2) (1)
Commitment to Social Justice (4) (3) (2) (1)
Please make any general comments here:
Please indicate your overall endorsement of this candidate:
_____Recommend highly
_____Recommend
_____Recommend with reservation
_____________________________________ ________________
Signature of person completing this form Date
Name: (Please type or print)_____________________________________
Position/Title:_________________________________________________
Organization/Company:________________________________________
Telephone #:______________________
Address:_____________________________________________________
_____________________________________________________________
PLEASE MAIL THIS FORM TO:
Carleen Guck
Department of Social Work
St. Cloud State University
Stewart Hall 224
720 4th Avenue South
St. Cloud, MN 56301-4498
OR
Fax to: 320-308-3285
Thank you!
4/04
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