Confidential Recommendation

[Printable Copy]

Name of Applicant__________________________________

Name of Reference_________________________________

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

Date_________________ Applicant’s Signature___________________________________________

RECOMMENDATION FORM

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

Judgment

____Exceptionally mature                                                              Ability to learn

____Above average decision making                                     ____Learns quickly

____Average decision making                                                   ____Learns readily

____Often uses poor judgment                                                   ____Average

____Consistently uses poor judgment                                     ____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, Ed.D., ATC, ATR,

Athletic Training Program Director,

117 Memorial Hall,

Winona State University,

Winona, MN 55987

Questions: 507-457-5214 Office

snelson@winona.edu  Email