Name of applicant
Program to which applicant is applying
Name of evaluator
Position of evaluator
Access Information
q I hereby waive my right to access to the information supplied on this form.
q I do not waive my right to access to the information supplied on this form.
Applicant’s signature date
To the evaluator: Please rate the applicant in comparison to others who have gone on for graduate study
by checking the appropriate boxes.
Top 5% Top 10% Top Third Middle Third Lower Third Unknown
Potential for independent study
Intellectual ability
Ability to work with others
Professional/ethical qualifications
Problem analysis ability
Breadth of knowledge
Written communication skills
Teaching ability
Oral communication skills
Proficiency as a scholar
Potential for graduate study
Please complete the back of this form.
Last First Middle Initial
Applicant Evaluation/
Recommendation Form
Please print or type
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During what time period?
How long have you known the applicant?
What do you consider to be the applicant’s principal strengths and weaknesses as a potential student? In what way will
graduate study better prepare the applicant to meet his or her goals? In order to help us evaluate the applicant, please
provide any additional information below or enclose a separate recommendation letter with this form.
Do you recommend the applicant for admission to the graduate program indicated?
q Yes q No q With reservations (please explain.)
Signature of evaluator
Typed/printed name of evaluator
Typed/printed address of the evaluator
Phone number of evaluator Date
E-mail address of evaluator
Completed forms must be signed by the evaluator and placed in an envelope
with the evaluator’s signature on the seal.
Return this envelope to the graduate student applicant.
It is the policy of Clarion University of Pennsylvania that there shall be equal opportunity in all of its educational programs, services, and benefits,
and there shall be no discrimination with regard to a student’s or prospective student’s race, color, religion, sex, national origin, disability, age, sexual
orientation/affection, gender identity, veteran status or any other factor that are in accordance with local, state, and federal laws. Direct equal opportunity
inquiries to Assistant to the President for Social Equity, 207 Carrier Administration Building, Clarion, PA 16214-1232, 814-393-2109.
City State Zip
Area Code
Typed or Printed
In what capacity? __________________________________________________________________________________
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