Fillable ALABAMA STATE UNIVERSITY HEALTH INFORMATION MANAGEMENT PROGRAM Confidential (Alabama State University)

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ALABAMA STATE UNIVERSITY HEALTH INFORMATION MANAGEMENT PROGRAM Confidential (Alabama State University)

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Revised 092016
ALABAMA STATE UNIVERSITY
HEALTH INFORMATION MANAGEMENT PROGRAM
Confidential Recommendation
TO BE COMPLETED BY APPLICANT (Please type or print legibly)
NAME _________________________________________________________________
Last First Middle
The Family Educational Rights and Privacy Act of 1974, and its amendments guarantee students access to
their educational records. Students are also permitted to waive their right of access to recommendations.
The following signed statement indicates the wish of the applicant regarding this recommendation.
Failure to respond will be considered a waiver of the right to this recommendation.
_____ I waive my right to inspect the contents of the following recommendation.
_____ I do not waive my right to inspect the contents of the following recommendation.
Signature _________________________________________ Date: ______________________
TO BE COMPLETED BY RECOMMENDER
If you wish to make additional comments, please attach a letter to this form.
1. How long have you known this applicant and in what capacity? _________________________
______________________________________________________________________________
2. How well do you feel you know the applicant? Casually_____Well______ Very Well_______
3. Please objectively rate the student in the following areas:
Excellent
Above
Average
Average
Below
Average
Self Motivation
Dependability
Judgment
Ability to cope
with stressful
situations
Problem Solving
Time
Management
Initiative
Revised 092016
Ability to accept
constructive
feedback
Communication
Assertiveness
Integrity
4. Please comment on the applicant’s strengths and weaknesses, including his/her character, personality,
maturity, or any other traits that may be pertinent to the applicant’s performance in this curriculum.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5. Please indicate your recommendation (check one)
___ Recommend Strongly ___ Recommend with Reservation
___ Recommend ___ Cannot Recommend
Comments: ____________________________________________________________________
Recommender’s
Name:
_______________________________________ Title: ______________________
Recommender’s
Signature: ____________________________________________ Date: ___________________
Organization: _________________________________________________________________
Address: _____________________________________________________________________
Telephone:
___________________________
Please mail the Recommendation form to: Health Information Management
Alabama State University
PO Box 271
Montgomery, AL 36101-0271
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ALABAMA STATE UNIVERSITY HEALTH INFORMATION MANAGEMENT PROGRAM Confidential (Alabama State University)

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Completed 16 August 2020

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