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Reference form
Section
I
(To
be
completed
by applicant)
The
following information
must
correspond exactly
to the
information submitted
on
your application. Indicate your decision regarding
a
waiver
of the
right
of access to this
reference before giving
it to the
person
who
will
be
submitting
the
reference. You should
then
give
the
form
to the
recommender
with a
self-addressed and stamped envelope.
Have the
recommender place
the
completed reference into
the
envelope,
seal it
and sign across
the seal. The
envelope should
be
returned
to
you and you should
send it to VCU in
accordance
with the
“A
pplication i
nstructions
page
at
www.admissions.vcu.edu/graduate.
Please
do
not
return
forms/letters
separately.
Social
Security
number
(
Optional
)
-
-
!
Name
last first middle
other
last name(s)
!
!
Program
for which you are
applying
(Complete
these items
exactly
as
you have completed
them on
your
application.)
!
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curriculum
specialization
(if applicable) track (if applicable) degree
!
Semester
and
year
of
entry
Fall
Spring
Summer
year year
year
!
Name
of
recommender
!
The
Family Education Rights and Privacy
Act of 1974
and
its
amendments guarantee students
access to
their educational records.
Students,
however,
are
entitled
to
waive their rights
of access
concerning recommendations.
The
following signed statement
is the
applicants
wish
regarding
this recommendation.
!
I
waive
my
rights
to
inspect
the
contents
of this reference.
I do not
waive
my
rights
to
inspect
the
contents
of this reference.
!
!
signature date signature date
Section
II
(To
be
completed
by recommender)
Virginia Commonwealth University will value your comments
on the
suitability
of this
applicant
to do
graduate
work
and will hold
your
comments
in
confidence
if the
applicant
has
signed
the
above
waiver.
!
How
long and
in what
capacities have you known
the applicant?
!
!
!
Please
carefully
assess the
applicant
in the
following areas.
In
making your assessment, compare
the
applicant
to
other individuals you
have
known
who
have similar levels
of
experience and
education.
!
!
Intellectual
ability
Superior
Good
A
verage
Poor
Unknown
Ability
to
analyze
a
problem and formulate
a solution
Competence
in
applicants general
field
Self-reliance
Leadership
Creativity/innovation
Motivation
Self-discipline
Cooperativeness
Oral communication
skills
Written communication
skills
Initiative
Reliability
Please use space on the back of this
form
to
elaborate
on the
applicants
qualifications.
Graduate Admissions
click to sign
signature
click to edit
click to sign
signature
click to edit
!
Reference form
VCU
Graduate Admissions
is
interested
in
obtaining
an
accurate profile
of the
applicants capability
for
graduate study. Since
we realize
that
check-off
items
sometimes
do not
provide you
the
opportunity
to
characterize
the
applicant
as
fully
as
you would
like, we
encourage you
to
provide additional comments
on the
applicants intellectual capability, motivation
for
seeking graduate education, and likely tenacity
in
following through
with the
opportunity
for
graduate education
(e.g.,
perseverance,
work
habits, organization).
If the
applicant
is
applying
to a
professional curriculum,
we are
interested
in
your comments about
the
applicants significant professional attitudes and behaviors. This
form
also may
be used as a
recommendation
for
financial assistance,
such as
teaching, research assistance
or fellowships.
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Your overall assessment
of the
applicant
as to his or her
ability
to
complete
an
advanced academic
degree:
!
Highly
recommend
Recommend
with reservation
!
Recommend without
reservation
Do not recommend
!
!
!
signature date
!
!
name (please
print)
!
!
institution
!
!
position
telephone
number
!
!
Place
the
completed
form in the
addressed
and
stamped envelope provided
by the
applicant.
Be sure to seal the
envelope
and sign
it
across
the seal
before returning
it to the
applicant.
Thank you for
assisting
us with our
self-
managed application
process.
Graduate Admissions
click to sign
signature
click to edit
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