Nursing Applicant Reference

The applicant has chosen this to be a confidential reference.
An honest and complete opinion will be most helpful.

The applicant has chosen this to be a non-confidential reference.
An honest and complete opinion will be most helpful.

This reference form is associated with the following Nursing program applicant. If this is incorrect, please update the first and last name of the applicant here.*

First Last

How long have you known this individual and in what capacity?*

From your experience with this individual please rate him/her in the following areas as they pertain to the practice of nursing.

Communication*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Coping*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Commitment to Task*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Conflict Management*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Problem-Solving*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Organization and Planning*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Grooming*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Punctuality*

Very strong evidence skill is present
Strong evidence skill is present
Some evidence skill is present
Insufficient evidence for or against skill
Strong evidence skill is not present

Would you recommend this person for the nursing program?*

Yes
No

Additional Comments

Date*

Name*

First Last

Phone Number*

Email Address*

Title

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How to Get Started

Start Here

Ways to Pay

Learn More

Find Your Program

Programs

Academic Resources

Other Services

Get Involved

Find Resources

Get Involved

Live on Campus

Ways to Give

EMPLOYMENT OPPORTUNITIES

Foundation & Alumni

Training & Grant Programs

Who We Are

Our Values

About Us

Organization

Nursing Applicant Reference

Nursing Applicant Reference Questionnaire