Department of Speech and Hearing Sciences
University of Washington
RECOMMENDATION FORM - Postbaccalaureate
UNIVERSITY OF WASHINGTON
SPEECH AND HEARING SCIENCES
1417 NE 42nd Street
Seattle, WA 98105-6246
(206) 685-7403
A.THIS SECTION TO BE COMPLETED BY THE APPLICANT (REVIEW THE APPLICANT STATEMENT BELOW):
Today's Date ______
Name ______Year student wishes to begin studies Summer 20_____
TO THE APPLICANT AND THE EVALUATOR:
Under the provisions of Public Law 93-380 and the University of Washington's Policy on Student Education Records, the recommendation will be available to the student if the student is or has been admitted and registered at the University unless the student waives such right to review.
FOR THE STUDENT: (Optional)
I hereby waive my right to review this recommendation.
______
SignatureDate
B.THIS SECTION TO BE COMPLETED BY THE EVALUATOR:
The person named above is applying to our program. We would appreciate your frank appraisal of his or her qualifications for successful study by filling out the brief section below and marking in the columns. When you have completed the form, please seal your recommendation in a business size envelope, sign on the seal in pen, and return to the applicant for submission to us. If you prefer, we will also accept recommendations sent directly to the address above. Recommendations must be postmarked no later than February 15.
Today's Date ______
Print Name ______Institution ______
Title ______Academic Department ______
Employment Mailing Address ______
______
May we contact you should we have further questions about this applicant? Yes No
Phone:______E-mail:______
How long have you known the applicant? ______years
How well do you know the applicant? (Please circle one) slightly averagefairly wellvery well
In what capacity do you know the applicant? ______
(OVER)
Department of Speech and Hearing Sciences
University of Washington
Don't Know / Below Average(Lower 25%) / Average
(Middle 50%) / Above Average
(Upper 25%) / Excellent
(Upper 10%)
Personal Qualities:
Judgment
Self-expression
Dependability
Personal Relationships
Working with others
Leadership
Preparation in Area:
Academic preparation
*Clinical preparation (if applicable)
Potential in Area:
Scholastic potential
*Potential as clinician (if applicable)
Overall: Compare with others at same level you have known in the last five years.
Please add a summary statement concerning the applicant's strengths, weaknesses, and potential as a postbaccalaureate student of speech and hearing sciences:
______
Signature of Evaluator
The University of Washington reaffirms its policy of equal opportunity regardless of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran. Any discriminatory action can be a cause for disciplinary action. This policy applies to all programs and facilities, including, but not limited to, admissions, educational programs, employment, and patient and hospital services. Discrimination is prohibited by Presidential Executive Order 11246, as amended, Titles VI and VII of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, Age Discrimination in Employment Act of 1975, Vietnam Era Veterans' Readjustment Assistance Act of 1974, Americans with Disabilities Act of 1990, State of Washington Gender Equity in Higher Education Act of 1989, other federal and state statutes and regulations and University policy. Coordination of the compliance efforts of the University of Washington with respect to all of these laws and regulations is under the direction of the Assistant Provost for Human Rights and Affirmative Action, Dr. Helen Remick, University of Washington, Equal Employment and Affirmative Action Office, 4045 Brooklyn Ave. N.E., Seattle, Washington 98105-6261, telephone (206) 543-1830, V/TTY.