Evaluator Signature: __________________________________________________________ Date:___________________________
In its educational policies, programs, and procedures, the University provides equal opportunity for all its students without regard to race, color, religion, sex, age,
disability, or national or ethnic origin.
5000 N. Willamette Blvd., MSC#177
Portland, Oregon 97203-5798
Recommendation Form: School of Nursing
Applicant Name (First and Last Name):________________________________ Applicant Email: _____________________________
Program of Interest:
Doctor of Nursing Practice Clinical Nurse Leader Nurse Educator
Evaluator Name (First and Last Name): ___________________________________________________________________________
Evaluator Position/Institution: __________________________________________________________________________________
Academic Professional (Employer/Supervisor)
Directions: Complete the following prompts and return either via email as a saved .pdf to email@example.com or printed document by
mail to the address above. Please be sure this completed form is included with your submitted letter of recommendation. All
recommendation letters must be signed and submitted by the recommender to be considered valid.
Approximately how long have you known the applicant?: _________ Years
Please rate the applicant in the following areas: *Click the boxes below for a checkmark to appear
Character and Personality
Overall Estimate for Potential for Success
Letter of Recommendation: Please include a letter of recommendation with this form that discusses the applicant’s
qualifications and potential to complete a graduate program, as well as the applicant’s promise of professional success.
At the top of your letter, please include the applicant’s first and last name as well as email. Refer to the above directions
for submission specifications.
click to sign
click to edit