Applicants to the UMass Amherst College of Nursing RN to BS in Nursing and Accelerated BS in Nursing
must submit one professional reference.
The reference should be from a person who is well acquainted with your work experience, academic
preparation, and performance, and who is able to judge your qualifications for professional nursing
(e.g. professor, employer, or other professional).
The reference should be emailed to:
Continuing and Professional Education Admissions Office
University of Massachusetts Amherst
admissions@oe.umass.edu
APPLICANT REFERENCE FORM
APP
L
I
C
AN
T
:
Instructions:
This form is to be forwarded to the person recommending you.
Under the Federal Family Educational Rights and Privacy Act of 1974, students are entitled to review their
record, including letters of recommendation. However, those writing recommendations and those
assessing recommendations may attach more significance to them if it is known that the recommendations
will remain confidential.
It is your option to waive your right to review these records or to decline to do so. Please mark your choice of
option and sign your name below.
I elect to keep this recommendation confidential. I waive all rights of access to this
recommendation, whether visual, oral, or written, as provided in the Family
Educational Rights and Privacy Act of 1974 and its amendments. I understand that this
recommendation will not be available for my inspection now or in the future.
OR
I elect to keep the recommendation nonconfidential, and the
recommendation may be
shown to
me
at
my request.
Type signature here: ______________________________________________
Da
te: _______________
INSTRUCTIONS TO RECOMMENDER
Please complete the following recommendation form to evaluate this applicant for a UMass Amherst
College of Nursing program.
Please DO NO
T complete this form if the candidate has failed to designate a confidentiality option above.
Your prompt response is appreciated.
NURSING
PROGRAM APPLICANT REFERENCE FO
RM
___________________________________________________________________
UNIVERSITY OF MASSACHUSETTS
A
MH
E
R
ST
College of
N
ur
s
i
n
g
APPLICANT
REFERENCE FO
RM
APPLICAN
T
S
NAM
E
:
LAST FIRST
M.I.
R
E
CO
MM
E
NDATION
NAM
E
:
LAST FIRST MI
A
DD
R
ESS:
C
I
TY:
ST
A
TE:
OCC
UPA
T
I
O
N:
HOW LONG HAVE YOU KNOWN THE
APP
L
I
C
AN
T?
RATE APPLICANT ON THE FOLLOWING CHARACTERISTICS:
Outstanding
Above Average
Average
Below Average
Poor
Unable to Rate
Organization
Oral Communication
Written
Communication
Critical Thinking
Problem Solving
Leadership Ability
Teamwork
Constructive
Feedback
Response
EMPLOYER:
RELATIONSHIP TO THE APPLICANT:
___________________________________________________________________________
_______________________________________________________________________________________
____________________________________________________________________________________
______________________________________________
_______________
_______________________________________
___________________________________________________________
_______________________________________________________________
ZIP:
____________________________________
_______________
Please describe any additional qualifications and traits you consider of special significance in judging the
applicant’s abilities to succeed in this program.
Type signature here:
Save the form, then email it to:
CPE Admissions Offi
ce
admissions@oe.umass.edu
____________________________________________
_______
Date: _______________
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