Revised: 11/22/2021
REFERENCE FOR MSE AND ED.S. APPLICANTS
Name of Applicant: ___________________________________________________________
Program of Study (check one):
_____Ed.S.(Education Specialist)
_____MSE Curriculum and Instruction:
Emphasis ___________________________ Community of Learning format ___
_____MSE Special Education
Thank you for your willingness to serve as a reference for this applicant who is applying for
graduate study at Wayne State College. In order for the graduate faculty to assess the
candidate’s potential for completing an academic program of study and for continuing as a
successful educational professional, we ask that you complete this questionnaire. Your
response will be kept in the student’s file, but please be advised that provisions in the Family
Educational Rights and Privacy Act (FERPA) do allow the student access to that file.
Please use the following rubric in responding to the questions: 1=poor, 2=average, 3=good,
4=exceptional
1. _____Academic potential 6. _____Collaborative decision making
2. _____Leadership potential 7. _____Conflict management
3. _____Verbal communication 8. _____Organizational skill
4. _____Written communication 9. _____Technology skill
5. _____People skills 10. _____ Ethical character
Additional comments:
Name: __________________________ Position: ___________________________
Phone: _________________________ Email: _____________________________
Thank you for your cooperation and prompt response. Please feel free to contact the School of
Education and Behavioral Sciences at 402-375-7164 should you have any questions or
concerns. Return this form directly or through the mail to: School of Education and Behavioral
Sciences, Benthack Hall 111, Wayne State College, 1111 Main Street, Wayne, NE 68787 OR
email it to Rhonda Sebade at rhsebad1@wsc.edu.
