Fillable Mphformc-fall 2012-programreferenceletter Fulbright Reference Report Waiver Form

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Mphformc-fall 2012-programreferenceletter Fulbright Reference Report Waiver Form

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PART I – ACCESS TO REFERENCE LETTER
The reference letter written by the evaluator below is confidential in accordance with the Family Education Rights and Privacy
Act of 1974, the California Information Practices Act of 1977, and related policies and regulations.
I hereby waive /do not waive my right of access to any information contained in the reference letter written by the
evaluator identified below.
Signature of applicant _______________________________________________ Date __________
Applicant and Evaluators. It is understood that this letter of recommendation will be retained in confidence by the Department
of Health Science, California State University, Fresno and will be used as one factor in consideration of the applicant to an
advanced and/or master's degree program.
N
ame of applicant
P
rogram applied for
Name of evaluator
Evaluator’s telephone number
Address City, State, Zip or Country
PART II—INSTRUCTIONS FOR THE INDIVIDUAL WRITING THE REFERENCE LETTER
The Department of Public Health would appreciate a statement from you evaluating the person named above for enrollment in
and successful completion of a master's degree program. Please attach this form to your letter of recommendation.
CATEGORY
EXCELLENT
ABOVE
AVERAGE
AVERAGE
POOR RISK
DO NOT
RECOMMEND
NOT
APPLICABLE
Scholastic Ability
Oral Expression
Written Expression
Enthusiasm
Initiative
Growing
Professionalism
Dependability/
Reliability
Problem Solving
Abilities
Overall Recommendation: Excellent Above Average Average Poor Risk Do Not Recommend
California State University, Fresno
Department of Public Health
Master of Public Health Program
2345 E. San Ramon Ave. M/S MH 30
Fresno, CA 93740-8031
559-278-8324
D
ate
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Mphformc-fall 2012-programreferenceletter Fulbright Reference Report Waiver Form

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Completed 26 May 2020

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