Fillable REFERENCE FORM (California State University, Bakersfield)

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REFERENCE FORM (California State University, Bakersfield)

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  • 24 check-boxes
  • 7 other fields

Country of origin: US
File type: PDF

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NONDISCRIMINATION POLICY
EUD does not discriminate on the basis of race, color, national origin, sex, physical handicap, or sexual orientation in the educational programs or activities it conducts. Students admitted with physical, perceptual or
learning disabilities will be given necessary accommodations provided that their disability has been verified by the CSUB Office of Services for Students with Disabilities (661-654-3360).
12.4.19 (RS)
MA IN EDUCATION - CURRICULUM & INSTRUCTION
REFERENCE FORM
9001 Stockdale Highway – 30BDC
Bakersfield, California 93311
661.654.2441 | 661.654.2447 (f)
extended.csub.edu
THIS REFERENCE FORM MUST BE EMAILED FROM THE REFEREE’S EMAIL ADDRESS AND NOT THE APPLICANT.
PLEASE EMAIL TO: r
salyards@csub.edu | Raushel Salyards, Lead Coordinator
I
n order to complete this fillable PDF form, you must save the file to your computer first. Once you have completed the form, you
can then save your responses and attach it to your email to submit. The PDF form will not save your results if done on a tablet or
smartphone. Alternatively, you can print, complete, and scan back into your email for submission.
All areas must be evaluated for the reference form to be considered valid.
APPLICANT NAME: ____________________________________________________
This recommendation form should be completed by an individual who has understanding of the applicant’s knowledge, skills, and dispositions
related to teaching. Please provide your judgment of the suitability of this candidate for the program according to the following dispositions:
DISPOSITION
DESCRIPTION
EVALUATION (PLEASE CHECK ONE)
Professional
Collaboration
The applicant works effectively with others. Strong Average Below Average Not Observed
Reflective
Practitioner
The applicant demonstrates problem
solving and critical thinking skills.
Strong Average Below Average Not Observed
Ethical
Professional
The applicant demonstrates ethical
behavior, consistent with professional
standards, obligations, and responsibilities.
Strong Average Below Average Not Observed
Student/Client
Centered
The applicant makes connections between
and among individuals and maintains
trusting relationships.
Strong Average Below Average Not Observed
Professional
Leader
The applicant demonstrates leadership
skills such as effective communication and
organization and the ability to ensure the
advancement, welfare and safety of the
students.
Strong Average Below Average Not Observed
Professional
Competence
The applicant demonstrates the potential
to positively impact K-12 learners.
Strong Average Below Average Not Observed
ANY ADDITIONAL COMMENTS (not required):
P
LEASE PROVIDE YOUR CONTACT INFORMATION SO THAT WE MAY CONTACT YOU IF WE NEED CLARIFICATION:
Name: _____________________________________________ Position: ____________________________________________
Phone: _____________________________________________ Email: ____________________________________________
Signature: _____________________________________________ Date: ____________________________________________
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REFERENCE FORM (California State University, Bakersfield)

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Completed 28 January 2021

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