California State University, Northern California Consortium Doctor of Nursing Practice
September 2017
Dear Colleague,
You have been listed as a reference by an applicant to the California State University,
Northern California Consortium Doctor of Nursing Practice program. Your insight
concerning this applicant will be very helpful in the decision-making process.
The reference aspect of the application process has two components. The first is a letter
of recommendation. The recommendation should reflect your knowledge about the
applicant’s advanced nursing practice experience, as well as their potential for
scholarship and leadership. Please write the recommendation letter on letterhead
stationery and address the letter to Dr. Sylvia Miller, DNP Program Director and Associate
Professor Fresno State (see address below).
The second component is a reference rating form. The applicant should have completed
the top portion of the reference rating form. We are requesting that you complete the
bottom portion of the reference rating form.
Once both items are complete (letter of recommendation and reference rating
form), put them in an envelope, seal it and sign across the sealed flap, and mail.
The application and letter of recommendation are time sensitive. Please confirm with the
DNP applicant the deadline for having the recommendation letter and reference rating
form completed and sent. We appreciate your assistance.
Sincerely,
Dr. Sylvia Miller, EdD, RN, FNP-C
DNP Program Director and Associate Professor Fresno State
School of Nursing
2345 E. San Ramon Avenue M/S MH25
Fresno, CA 93740-8031
P 559.278.4788
E symiller@csufresno.edu
California State University, Northern California Consortium Doctor of Nursing Practice
September 2017
REFERENCE RATING FORM
DNP Applicant to complete top portion
Applicant Name: __________________________________________________
Applicants are advised that upon their admission to the School of Nursing, the Family
Educational Rights and Privacy Act of 1974 accords them the right to review these
recommendations unless that right is waived. While applicants are not required to agree
to make such a waiver, they are further advised that some individuals may not be willing
to supply a letter of recommendation in its absence. I have requested that this rating form
be completed by _________________________________________________ (name of
person writing the letter of recommendation and completing the reference rating form) for
use in the admission process to the DNP program. In accordance with the Family
Educational Rights and Privacy Act of 1974 I hereby:
_____ waive access to this report which should be considered confidential
_____ do not waive access to this report
___________________________________________________________________
Applicant’s Name – Print Clearly
___________________________________________________________________
Applicant’s Signature Date
Recommender to complete bottom portion and page 3
Please complete the rating scale below and attach to your letter of recommendation.
Place a circle or an “x” over the appropriate number that represents the applicant’s
rating. The rating of a 1 is Low and the rating of a 7 is High.
Independence and Self-Direction: sets own goals, organizes and prioritizes work, and
initiates/sustains activity to achieve goal
1 2 3 4 5 6 7
Responsibility and Accountability: responsible, dependable and accountable for own
actions
1 2 3 4 5 6 7
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signature
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California State University, Northern California Consortium Doctor of Nursing Practice
September 2017
Oral Communication: demonstrates professional and interpersonal communication
skills
1 2 3 4 5 6 7
Critical Thinking: analyzes complex concepts, issues, ad problems by identifying
critical components and their relationships
1 2 3 4 5 6 7
Creativity: develops new approaches, novel ideas, and imaginative solutions
1 2 3 4 5 6 7
Interpersonal Relationships: works collaboratively and cooperatively with others
1 2 3 4 5 6 7
Leadership: has vision for future; inspires confidence and is respected by others; takes
initiative in group work
1 2 3 4 5 6 7
Overall Rating of Applicant: overall rating as compared to other master’s applicants in
nursing
1 2 3 4 5 6 7
______________________________________________________________________
Recommender Signature Date
______________________________________________________________________
Title Organization
_________________________________________
Work Phone
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signature
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