Recommendation for Graduate Admissions
Part 1 - Applicant's Information (Please print or type)
Instructions to the applicant: Complete Part 1 of this form and give a copy to each person who will write a recommendation for you.
If you are applying to the Physical Therapy (D.P.T.) or Counseling (M.S.Ed.) programs, you should also include a self-addressed, stamped envelope. Ask
the recommender to seal the recommendation inside an envelope, sign across the seal, and return it to you. Return the UNOPENED envelopes with
your application package. Applicants to all other programs should ask the recommender to forward the recommendation directly to the Office of
Graduate Admissions at the address above.
Applicant's Name (last, first, middle)
If records may appear under a different name, please enter
Old Dominion program applied to: Social Security No.
Check one of the following statements and sign your name.
Part 2 - Recommendation (Please print or type)
Instructions to the writer: If you are recommending an applicant to the Physical Therapy (D.P.T.) or Counseling (M.S.Ed.) programs, please place your
completed form in the envelope provided by the applicant, sign across the seal, and return it to the applicant as soon as possible. Recommendations
for applicants to all other programs should be returned directly to the Office of Graduate Admissions at the address above.
Name of person making recommendation below.
How long have you known the applicant?
In what capacity?
Rate the applicant in comparison with others of similar age and position you have known within the past five years.
Good Excellent Outstanding
(top 5% in class)
Motivation for proposed
field of study
If possible, indicate the number of others with whom you are comparing this applicant.
High Adequate Low No basis for judgment
Would you admit the applicant to your department? Assuredly Probably Possibly No
Feel free to provide additional comments below, or as an attachment.
Office of Graduate Admissions • Old Dominion University • Norfolk, VA 23529 • (757) 683-3685
(photocopy for use)
How do you rate the applicant's potential as a teaching assistant?
I WAIVE my rights to see my evaluation and therefore recognize that it will remain confidential.
I DO NOT WAIVE my rights of confidentiality and therefore will be able to see my evaluation.
(Top 50% in class)
(top 25% in class)
(top 15% in class)