EMU School of Graduate and Professional Studies
emu.edu/dnp | Email: dnp@emu.edu
Phone: 540-432-4187
Evaluation of Applicant’s Performance and P otential
Graduate Program in Nursing
To the recipient:
Doctor of Nursing Practice
Eastern Mennonite University
1200 Park Rd
Harrisonburg, VA 22802
To the applicant:
Please complete the upper portion of the evaluation form.
Give a form to three persons familiar with your academic
and/or employment record. (See admission requirements
for more details.)
Applicants to Eastern Mennonite University are selected in accordance with nondiscriminatory practice.
Name of applicant:
Last First Middle or Birth Name
Address:
Street/Route/Post office box City State/Province ZIP/Postal code Country
Pursuant to federal law, a student admitted to the Department of Nursing is entitled to inspect the evaluation in his/her file, unless the
student has signed a waiver of this right of access. However, the department does not require a waiver as condition for admission, receipt
of financial aid or receipt of any other services or benefits from the department. Applicants submitting names of individuals for letters of
recommendation, therefore, are free to determine whether or not they wish to waive their potential right to examine such evaluations.
Waiver
The Family Education Rights and Privacy Act permits us to request, but not require, that you waive your right to inspect this evaluation.
This right, which we request that you waive, would arise if you were an enrolled student at Eastern Mennonite University and if the
evaluation were maintained after your enrollment. In considering whether you will waive, please be advised that the information contained
on this form will be used to evaluate you as an applicant for admission to the Eastern Mennonite University Department of Nursing. If you
elect to waive your rights of access to and review of this information, please sign your name.
Date Applicant’s signature
Evaluator’s name: Position:
Address:
Phone: Email:
The named applicant is a candidate for admission to the Eastern Mennonite University Doctor of Nursing Practice program.
We would appreciate your evaluation of the applicant’s performance and potential for success in an advanced role in nursing.
Your comments will be used by the faculty members of the Department of Nursing to help them arrive at a better
understanding of the applicant. Your cooperation in completing and promptly returning this form will assist both the
applicant and the Department of Nursing.
click to sign
signature
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