BSW Hybrid Program
Page 2 of 2
REV 12/30/19
3. We believe that such personal qualities as intelligence, maturity, emotional stability, sensitivity, resourcefulness, initiative,
follow-through, sound judgment, and a respect for others’ diversity are important for successful professional practice. Please
assess the applicant’s academic and/or professional promise within this context by attaching a separate letter with this reference
form.
4. Summary Evaluation (please check only one)
____________ I strongly recommend this applicant for admission and believe that he/she has the capability to perform at a
superior level.
____________ I recommend this applicant for admission and believe his/her performance will be comparable to that of most
upper division students.
____________ I think that the applicant’s qualifications are marginal, but if admitted, the applicant would greatly benefit from
study in this program.
____________ I do not recommend this applicant for admission to the Baccalaureate Social Work Hybrid Program.
Signature_____________________________________________________ Date_____________________________________
Name____________________________________________________ Degree_______________________________________
Position__________________________________________ Employer_____________________________________________
Business Address (Street & No.)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
City_________________________________ State_____________________ Zip Code________________________________
May we call you for additional information? ____Yes ____No
Phone _____________________________________ Email address________________________________________________
Please return this form and your letter directly to the applicant in a sealed envelope.
Please sign the envelope on the back of the sealed flap.
Thank you for your cooperation.