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
Telephone: 503.943.7107
Email: gradschl@up.edu
Fax: 503.943.7178
Website: www.up.edu/graduate
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: __________________________________________________________________________________
Evaluator Type:
Academic Professional (Employer/Supervisor)
Directions: Complete the following prompts and return either via email as a saved .pdf to gradschl@up.edu 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
No Basis to Evaluate
Character and Personality
Conflict Resolution
Accepts Criticism
Academic/Professional Ability
Written Communication
Oral Communication
Interpersonal Communication
Clinical/Work Performance
Commitment to Profession
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 applicants first and last name as well as email. Refer to the above directions
for submission specifications.
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