Reference Information Name Reference email address In what capacity have you known the student? How long have you known the student? Student Information Name Check the response which most accurately describes the student in each of the following areas: The student exhibits a non-blaming attitude. Always Usually Seldom Never Unable to Assess The student is dependable. Always Usually Seldom Never Unable to Assess The student demonstrates concern for others. Always Usually Seldom Never Unable to Assess The student interacts well with others. Always Usually Seldom Never Unable to Assess The student is strongly motivated for professional social work practice. Always Usually Seldom Never Unable to Assess The student communicates clearly. Always Usually Seldom Never Unable to Assess The student refrains from imposing values on others. Always Usually Seldom Never Unable to Assess What strengths would you say this student brings to the social work profession? What weaknesses would you say this student needs to address before entering the social work profession? Additional comments: Which of the following accurately reflects your recommendation of this student to the Social Work Program at Mississippi College? Strongly recommend without reservation Recommend without reservation Recommend with reservation Do not recommend By typing your name below, you certify all information is true and correct to the best of my knowledge. Signature
