Under the terms of the Family Educational Rights Privacy Act, 20 U.S.C. 1232(g), you may, but are not required to waive your right of access to confidential references given for the purpose of admission to the Exercise Science: Athletic Training major at Winona State University.

                    _______I waive my right to access                              _______ I do not waive my right to access

Relations with others                                                                                                                                 Quality of work

____Exceptionally well accepted                                                                                                               ____Excellent

____Works well with others                                                                                                                      ____Very good

____Difficulty working with others                                                                                                           ____Average

____Works poorly with others                                                                                                                 ____Below average

____Poor

Dependability

____Completely dependable                                                                                                                Grooming

____Above average                                                                                                                                 ____Excellent

____Usually dependable                                                                                                                         ____Very good

____Sometimes neglectful or careless                                                                                                   ____Average

____Unreliable                                                                                                                                           ____Below average  

                                                                                                                                                                      ____Poor

Judgement

____Exceptionally mature                                                                                                                         Ability to learn

____Above average decision making                                                                                                      ____Learns quickly

____Average decision making                                                                                                                 ____Learns readily

____Often uses poor judgement                                                                                                              ____Average

____Consistently uses poor judgement                                                                                                  ____Below average

____Poor

Attitude-Application to Work

____Outstanding enthusiasm                                                                                                            Overall Evaluation

____Very interested and industrious                                                                                                  ____Outstanding

____Average diligence and interest                                                                                                  ____Very good

____Somewhat indifferent                                                                                                                     ____Average

                                                                                                                                                                    ____Poor

Please attach a letter of recommendation that addresses the candidates potential for success in an allied Healthcare Profession.

_____________________________________________________________________________________

Name of Reference (Type or Print)                                                              Signature

______________________________________________________________________________________

Title                                                                                                                  Date

______________________________________________________________________________________

Address                                                                                                          Telephone

Send to: Shellie F. Nelson, M.S., ATC/R, Athletic Training Program Director, 117 Memorial Hall, Winona State University, Winona, MN 55987