Graduate School Psychology Programs Reference Form

Student Name

Do you know the student well enough to give a recommendation?

Yes

In what capacity and during what period of time have you known this applicant?

Please compare the applicant in the scale below with a representatitve group of students with whom you have interacted during your career (please specify the reference group you are using, e.g., first year graduate students, seniors, employees, etc.)

Reference Group

Ability to Work Independently

I would recommend the applicant if he/she were academically qualified.

What information do you have about this applicant that is relevant to his/her pursuit of a degree/license in psychology?

On campus, in school and/or in the community, what contributions has the applicant made?

Is the applicant's record an accurate index of his/her potential?

Yes

Do Not Know

Some with the potential to be satisfactory or exceptional graduate students have inconsistent or marginal academic records. If you answered No to the above question, explain

Do you have other comments on the applicant's promise as a graduate student in psychology?

Reference Information/Letter (Optional)

Recommender's Name

Position/Title

Institution/Place of Work

Phone Number

Email Address

Today's Date

Graduate School Psychology Programs Reference Form

Psychology Programs Reference Form

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