Fillable Reference Forms 9.17

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Reference Forms 9.17

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  • 6 check-boxes
  • 36 other fields

Country of origin: US
File type: PDF

U.S.A. forms for California State University, Fresno

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FRESNO STATE
DEPARTMENT OF SOCIAL WORK EDUCATION
TITLE IV-E BSW CHILD WELFARE PROGRAM
BSW REFERENCE FORM
DATE:
APPLICANT NAME:
REFERENCE NAME:
The above named individual is applying for acceptance into the Title IV-E BSW Child Welfare Stipend
Program for the academic year of at CSU/UC at _____________________.
The curriculum for this program is designed to educate and prepare individuals for a beginning level of
professional practice within the field of Public Child Welfare. We are seeking individuals who possess a
genuine and sincere interest in and commitment to working with at risk children and families within the child
welfare system. Because of the challenging nature of this field of practice, it is vitally important that
individuals demonstrate the qualities and skills necessary to problem solve and meet the special critical needs
present in diverse populations. We are therefore seeking those candidates who strongly represent and adhere to
the principles reflected in the NASW Code of Ethics to maintain the standards of the profession of Social
Work.
This student has selected you as a source of reference. We are depending upon you to provide us with the
information to help us access this student’s suitability to meet the expectations of this program. We strongly
believe that it is unethical to admit an applicant who is not committed to working with children and families,
whose ability to successfully complete the program is doubtful, or who is not suited for the professional role of
Child Welfare Worker. Your thoughtful evaluation of this student’s potential and readiness for professional
practice and specialization in the field of child welfare is very important to us.
We thank you in advance for your assistance in this matter and ask you to please respond to the following
questions. If you need more space, you are welcome to expand your responses on a separate sheet.
1. How long and in what capacity have you known the applicant?
years months
(Specify capacity: supervisor, professor, Advisor, etc.)
2. Please explain what you consider to be the applicant’s major areas of strength as a candidate
for the specialization in child welfare practice?
3. Please explain what you consider to be the applicant’s area of limitation(s) that need to be
strengthened to foster success in working with children and families?
4. Using the following scale from 0 to 3, (0= below standard, 1= average, 2= above average,
and 3 = exceptional), please address the applicant’s capacity in the following areas: (Please
use the * symbol if you are unable to evaluate the area based upon lack of
opportunity).
Questions:
0-3 or *of
unknown
Demonstrates intellectual ability
Ability to respect and work with diverse populations
Sensitivity to the needs and feelings of others
Ability to establish positive working relationships with others
Demonstrates professional work habits
Commitment to values & ethics of the social work profession
Ability to be accountable for professional practice in working with others
Willingness to accept direction, recommendations, and/or supervision
Demonstrates a positive level of common sense/judgment
Demonstrates acceptable levels of emotional stability
Demonstrates ability to problem solve utilizing positive strategies
Ability to complete task/assignments in a timely manner
Ability to solicit help/assistance when needed
Ability to effectively communicate in writing
Ability to effectively communicate verbally
Applicants overall potential for child welfare social work
5. Recommendation: (Please check one):
I am unable to make a recommendation at this time. Please explain in
“Comments” section on next page.
I do not recommend this applicant for acceptance into the Title IV-E Program.
California State University, Fresno
8
Department of Social Work Education
I recommend this applicant with some reservations, but if admitted, I believe the
applicant would benefit from study in the program. Please explain your reservations in
“Comments” section below.
I recommend this applicant for acceptance and believe this person will perform at a
standard level of performance comparable to most undergraduate students.
I highly recommend this applicant for acceptance and believe this person will
perform at a level above most undergraduate students.
I most highly recommend this applicant for acceptance and believe this person will
perform at an exceptional level above most undergraduate students.
6. Additional Comments:
Please Print Name of Reference: Date:
Signature of Reference:
Name of School or organization:
Address:
Title: Phone #:
Email Address:
Special Note: Reference Forms will not be accepted without a signature and a date. All
forms are due upon application deadline.
Thank you for your time and commitment in fostering quality in social work practice.
Please place your letter in an enclosed envelope, seal the envelope and sign your name across the
seal and return the sealed letter to the applicant.
Fresno State
9.17
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Completed 1 June 2020

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