Letter of Reference 9 08 .pdf

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LETTER OF REFERENCE
PLEASE MAIL THE COMPLETED FORM DIRECTLY TO:
The Graduate School, University of Louisiana at Lafayette, P.O. Box 44610, Lafayette, LA 70504-4610
Under the provisions of the Family Educational and Privacy Act of 1974, this applicant (if admitted and enrolled) will have access to the
information provided below unless he/she has waived such access.
TO THE APPLICANT: Please complete the top section.
Name of Applicant
(LAST)

(FIRST)

(MIDDLE)

Address
CITY

BOX OR STREET

Date of Birth

STATE OR COUNTRY

ZIP CODE

Student ID Number

Graduate program to which application is made
(Optional) I hereby waive my right to access the material recorded below.
SIGNATURE OF APPLICANT

DATE

TO THE RESPONDENT: Please include your judgment of this candidate's qualifications and promise, intellectual ability, motivation and
capacity for research or for acquiring professional skill, promise for a career in productive scholarship and effective teaching, quality of
previous work, and character and personality.

(Please continue on the other side of this sheet)
For comparative assessment, please check the boxes below:
I would compare this applicant with other students of the same level as follows:
Intellectual Ability
Writing Ability
Speaking Ability
Academic Preparation
Motivation
Maturity
Teaching Ability
Research Ability

TOP 10%

TOP 20%

How long have you known this applicant?

TOP 40%

BELOW 50%

UNKNOWN

In what capacity?

The evaluation level of the group with whom the applicant is compared is:
College seniors
First year master's students

Second year master's students
Doctoral students

Other (specify)
Would you accept this student into your graduate program?
YES

NO

YES WITH RESERVATION (please specify)

RESPONDENT'S SIGNATURE

DATE

NAME (PRINTED OR TYPED)

ADDRESS

TITLE

Revised 9/08



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