Undergraduate Programs Recommendation Form

Science or Math Professor

TO THE EVALUATOR: The person whose name appears below is applying to an undergraduate nursing program at Duquesne University School of Nursing and has asked you for a recommendation. This recommendation will be used solely for evaluation for admission purposes. The applicant will not at any time have access to this recommendation.

Applicant*

First NameMiddle NameLast NameMaiden Name (if known)

How do you know the applicant?

How long have you known the applicant?

In comparison with other candidates for undergraduate school that you have known, please rate the applicant on the following:

	Outstanding (A)	Very Good (B)	Average (C)	Below Average (D)	Unable to Assess (unobserved or too soon to tell)
Accepts feedback
Ability for critical thought and analysis
Communication skills (Oral and Written)
Judgment and Decision making
Ethical standards and Integrity
Initiative and Motivation
Interpersonal skills

Your Recommendation:*

Highly recommend (A)Recommend (B)Recommend with Reservation (C)Do Not Recommend (D)

Please provide a narrative in support of your response to the above rating categories and your overall recommendation response (highly recommend, recommend, recommend with reservation, do not recommend):

Your Name*

First NameMiddle NameLast Name

Position or Title*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

May an Admissions Committee member contact you if needed?

YesNo

By checking this box I verify my identity as entered above and that all responses are truthful and represent my knowledge of the applicant.*

Yes

PLEASE PRINT A COPY OF THIS FORM FOR YOUR REFERENCE BEFORE SUBMITTING!