History Undergraduate
Revised 04/13/2020
School of Education
Recommendation Form
The individual identified below is applying for acceptance into the School of Education at
Southern Connecticut State University. This requires letters of recommendation from
professionals able to testify to the individual’s suitability for admission to a teacher
preparation program. Letters of recommendation need to be accompanied by this completed
rating form.
Please complete this rating form and include it with your letter of recommendation,
which should more fully elaborate upon your ratings of this applicant and any other
relevant matters.
Mail your letter and form to: Professor Kelly
Falvey falveyk1@southernct.edu
History Department, Engleman C 205A
Southern Connecticut State University 501
Crescent Street
New Haven, CT 06515
Applicant Name:_________________________ Certification Area:___________________
I hereby waive my right of access under the Family Education Rights and Privacy Act of 1974
to specific and composite letters of recommendation:
Applicant’s Signature:____________________________ Date:__________________
How long and in what capacity have our known the applicant?
Please rate the applicant named above relative to other individuals you have known in a similar capacity:
Excellent Good Poor No Information
Intellectual Curiosity
If unable to report, calls
supervisor promptly
History Undergraduate
Revised 04/13/2020
Excellent Good Poor No Information
Works and relates well
with others
Performs assignments
Ability to analyze a
problem and formulate a
Asks questions when in
Approaches assignments
with seriousness
Exhibits interest and
Accepts supervision in a
positive fashion
Learns from every
Expresses opinion and
disagreements in a
mature manner
Is flexible with changes
Seeks opportunities to
Demonstrates sensitivity
to diversity of
confidentiality when
Accepts responsibility
with commitment
History Undergraduate
Revised 04/13/2020
Excellent Good Poor No Information
Demonstrates attitudes
and dispositions relevant
to pursuit of teaching
effectively: Oral
effectively: Written
Additional Comments:
___________________________________ ______________________________
Recommender’s Signature Print Name
Recommender’s Address City State/Zip Code
Phone Title/Position