Honors Program Reference Form

TO BE COMPLETED BY REFERENCES

An applicant for admission to Cairn University’s Honors Program has given your name as a reference. Please complete and submit the form below. Your candid evaluation of the applicant is appreciated. Thank you for taking the time to assist in the application process.

Honors Program Reference - Formstack

Applicant's Name*

First Name

Last Name

What is your relationship to the applicant?*

How long have you known the applicant?*

How well do you know the applicant?*

Please give an evaluation of the applicant in each of the following areas:

Please give an evaluation of the applicant in each of the following areas:
	Unsatisfactory	Below Average	Average	Above Average	Exceptional	No Basis for Judgment
Intellect	Please give an evaluation of the applicant in each of the following areas:: Intellect (Unsatisfactory)	Intellect (Below Average)	Intellect (Average)	Intellect (Above Average)	Intellect (Exceptional)	Intellect (No Basis for Judgment)
Motivation/Initiative	Motivation/Initiative (Unsatisfactory)	Motivation/Initiative (Below Average)	Motivation/Initiative (Average)	Motivation/Initiative (Above Average)	Motivation/Initiative (Exceptional)	Motivation/Initiative (No Basis for Judgment)
Aptitude for Problem Solving	Aptitude for Problem Solving (Unsatisfactory)	Aptitude for Problem Solving (Below Average)	Aptitude for Problem Solving (Average)	Aptitude for Problem Solving (Above Average)	Aptitude for Problem Solving (Exceptional)	Aptitude for Problem Solving (No Basis for Judgment)
Leadership Ability	Leadership Ability (Unsatisfactory)	Leadership Ability (Below Average)	Leadership Ability (Average)	Leadership Ability (Above Average)	Leadership Ability (Exceptional)	Leadership Ability (No Basis for Judgment)
Cooperativeness	Cooperativeness (Unsatisfactory)	Cooperativeness (Below Average)	Cooperativeness (Average)	Cooperativeness (Above Average)	Cooperativeness (Exceptional)	Cooperativeness (No Basis for Judgment)
Creativity	Creativity (Unsatisfactory)	Creativity (Below Average)	Creativity (Average)	Creativity (Above Average)	Creativity (Exceptional)	Creativity (No Basis for Judgment)
Maturity	Maturity (Unsatisfactory)	Maturity (Below Average)	Maturity (Average)	Maturity (Above Average)	Maturity (Exceptional)	Maturity (No Basis for Judgment)
Verbal Communication Skills	Verbal Communication Skills (Unsatisfactory)	Verbal Communication Skills (Below Average)	Verbal Communication Skills (Average)	Verbal Communication Skills (Above Average)	Verbal Communication Skills (Exceptional)	Verbal Communication Skills (No Basis for Judgment)
Written Communication Skills	Written Communication Skills (Unsatisfactory)	Written Communication Skills (Below Average)	Written Communication Skills (Average)	Written Communication Skills (Above Average)	Written Communication Skills (Exceptional)	Written Communication Skills (No Basis for Judgment)

Please use the space below to provide any additional information that may be helpful in evaluating the qualifications of the applicant.

Reference's official recommendation:*

I strongly recommend the applicant for admission. I recommend the applicant for admission. I do not recommend the applicant for admission. I recommend the applicant for admission with the following reservation:

I need to discuss this recommendation by phone.

Contact Information

Name*

First Name

Last Name

Title*

Organization*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Phone*

Email*

Signature*

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