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Counselor Education Programs Reference Form

Graduate School Counselor Education Programs Reference Form

Counselor Education Programs Reference Form

The student for whom you are submitting this reference was given the opportunity to choose whether s/he can review his/her recommendations (In compliance with The Family Education Rights and Privacy Act of 1974).

Student Name

PERSONAL QUALITIES: reliable, stable, trustworthy, positive, cooperative, reasonable

Unacceptable

Marginal

Acceptable

Good

INDUSTRY-WORK HABITS: determined, thorough, self-directed, prompt, follows through, energetic, responsible

Unacceptable

Marginal

Acceptable

Good

JUDGMENT: good sense, use of reason, sees relationships, discerning

Unacceptable

Marginal

Acceptable

Good

POISE: composure, appearance and manner, deportment, self-control

Unacceptable

Marginal

Acceptable

Good

VERBAL SKILL: effectiveness in oral communication, articulate, appropriate in oral expression and giving direction

Unacceptable

Marginal

Acceptable

Good

WRITING SKILL: effective written expression via papers, reports, etc., command of written language

Unacceptable

Marginal

Acceptable

Good

INTERPERSONAL SKILL: listening to others, respectful, empathic, self-confident, supportive, facilitative

Unacceptable

Marginal

Acceptable

Good

OVERALL RATING: normally an average of the seven items listed above

Unacceptable

Marginal

Acceptable

Good

Comments

I would hire applicant if he/she were academically qualified.

Yes

With Reservation

On the basis of his/her overall qualifications, I would recommend applicant for admission to the Counselor Education Programs at Emporia State University.

Yes

With Reservation

Recommender's Name

Position/Title

Institution/Place of Work

Phone Number

Address

Today's Date