Southeastern Louisiana University
College of Nursing and Health Sciences
Graduate Nursing Program
STATEMENT OF RECOMMENDATION
To the Applicant: This form should be completed by at least one current or previous program faculty who
can evaluate your potential for graduate study, one current or previous clinical supervisor who can evaluate
your current clinical competency and skills, and one other appropriate nursing professional who can attest to
your nursing competencies and skills. Type or print the top section yourself.
Name: ___________________________________________________________________________________
Seeking Admission for: MSN ________________ DNP ___________________
Should you be admitted to the University, you would have the right, as a student, to review your permanent record
including this recommendation form on file with the University. Some persons prefer not to complete
recommendation forms, however, unless they can be assured of the confidentiality of their comments. In any event,
your application for admission will be given full consideration based on all the information accumulated in your
application file, including this form, regardless of your decision on waiving your right to future review.
I do waive my right to subsequent access to this recommendation form
I do not waive my right to subsequent access to this recommendation form.
Applicant Signature: ____________________________________________________ Date: ________________
Person providing the reference:
Name/Title: __________________________________________________________________________________
Institution//Organization: ________________________________________________________________________
Address: ________________________________________________ Telephone: __________________________
Relationship to Student: _________________________________________________________________________
Please numerically indicate the value that most approximately rates this individual's performance
4=Excellent
3=Above Average
2=Average
1=Below Average
Not able to evaluate
Academic ability
Written
Communication
Verbal
Communication
Knowledge of
Specialty area
Motivation
Emotional
stability
Ability to work
independently
Ability to work in
a group
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Southeastern Louisiana University
College of Nursing and Health Sciences
Graduate Nursing Program
STATEMENT OF RECOMMENDATION
4=Excellent
3=Above Average
2=Average
1=Below Average
Not able to evaluate
Leadership skills
Initiative
Professionalism
Responsiveness to
Feedback
Research Potential
Ability to Problem
Solve
Please use the rest of this form to share your evaluation of the applicant’s suitability to pursue graduate or
doctoral level study. Attach an additional page if necessary.
1. How well do you know the applicant? How long and in what capacity?
2. Give your opinion of the applicant’s ability to do graduate work?
3. Give your opinion of the applicant’s expertise in his/her field.
4. Please add any additional comments:
Master’s Program
I would strongly recommend for
I would recommend for
I would recommend with reservations for
I would not recommend for
Referee Signature: ______________________________________________________ Date: _________________
This form and accompanying documents should be submitted to:
Graduate Coordinator
School of Nursing
SLU 10448
Hammond, LA 70402
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