Peru State College Graduate Programs - Recommendation form

Peru State College | Graduate Programs Office
PO Box 10 | Peru NE 68421
402-872-2314 | 1-800-742-4412
GraduatePrograms@Peru.edu.

Note: This form is not to be completed by a family member. All data will be transmitted securely.

Date Date / MM / DD YYYY
Name of Graduate Programs Applicant: Name of Graduate Programs Applicant: * First Last
Please describe your relationship with this applicant: *
Completion Instructions:

Thank you for agreeing to complete this reference form. We appreciate your time, input, and willingness
to assist the applicant in this capacity. Please note that Public Law 93-380, the Family Education Rights
and Privacy Act of 1974 grants all students the right to inspect and review all of their official records.

Please indicate the level at which this applicant currently demonstrates each disposition by selecting the appropriate option below. *
	Outstanding	Acceptable	Evolving	Unacceptable
The applicant independently seeks opportunities to engage in learning.	The applicant independently seeks opportunities to engage in learning.Outstanding	The applicant independently seeks opportunities to engage in learning.Acceptable	The applicant independently seeks opportunities to engage in learning.Evolving	The applicant independently seeks opportunities to engage in learning.Unacceptable
The applicant appreciates the importance of diversity and the impact diversity has in living a rich, full life.	The applicant appreciates the importance of diversity and the impact diversity has in living a rich, full life.Outstanding	The applicant appreciates the importance of diversity and the impact diversity has in living a rich, full life.Acceptable	The applicant appreciates the importance of diversity and the impact diversity has in living a rich, full life.Evolving	The applicant appreciates the importance of diversity and the impact diversity has in living a rich, full life.Unacceptable
The applicant demonstrates self-direction and initiative.	The applicant demonstrates self-direction and initiative.Outstanding	The applicant demonstrates self-direction and initiative.Acceptable	The applicant demonstrates self-direction and initiative.Evolving	The applicant demonstrates self-direction and initiative.Unacceptable
The applicant values the roles of community and families in learning and developing.	The applicant values the roles of community and families in learning and developing.Outstanding	The applicant values the roles of community and families in learning and developing.Acceptable	The applicant values the roles of community and families in learning and developing.Evolving	The applicant values the roles of community and families in learning and developing.Unacceptable
The applicant practices reflective and critical thinking.	The applicant practices reflective and critical thinking.Outstanding	The applicant practices reflective and critical thinking.Acceptable	The applicant practices reflective and critical thinking.Evolving	The applicant practices reflective and critical thinking.Unacceptable
The applicant values collaborative, cooperative, and inclusive learning environments.	The applicant values collaborative, cooperative, and inclusive learning environments.Outstanding	The applicant values collaborative, cooperative, and inclusive learning environments.Acceptable	The applicant values collaborative, cooperative, and inclusive learning environments.Evolving	The applicant values collaborative, cooperative, and inclusive learning environments.Unacceptable
The applicant demonstrates professional responsibility.	The applicant demonstrates professional responsibility.Outstanding	The applicant demonstrates professional responsibility.Acceptable	The applicant demonstrates professional responsibility.Evolving	The applicant demonstrates professional responsibility.Unacceptable
The applicant’s decisions, interactions, and behaviors positively impact the culture and climate of the learning environment.	The applicant’s decisions, interactions, and behaviors positively impact the culture and climate of the learning environment.Outstanding	The applicant’s decisions, interactions, and behaviors positively impact the culture and climate of the learning environment.Acceptable	The applicant’s decisions, interactions, and behaviors positively impact the culture and climate of the learning environment.Evolving	The applicant’s decisions, interactions, and behaviors positively impact the culture and climate of the learning environment.Unacceptable
The applicant values and demonstrates professional preparedness through organization, planning, and goal setting.	The applicant values and demonstrates professional preparedness through organization, planning, and goal setting.Outstanding	The applicant values and demonstrates professional preparedness through organization, planning, and goal setting.Acceptable	The applicant values and demonstrates professional preparedness through organization, planning, and goal setting.Evolving	The applicant values and demonstrates professional preparedness through organization, planning, and goal setting.Unacceptable
The applicant is dependable, punctual, demonstrates honesty and integrity.	The applicant is dependable, punctual, demonstrates honesty and integrity.Outstanding	The applicant is dependable, punctual, demonstrates honesty and integrity.Acceptable	The applicant is dependable, punctual, demonstrates honesty and integrity.Evolving	The applicant is dependable, punctual, demonstrates honesty and integrity.Unacceptable

Comments to the above questions:
Overall scholarly/professional ability. In comparison with a representative group of professionals with whom you have worked, how do you rate the general all-around scholarly/professional ability of the applicant: *

Overall scholarly/professional ability. In comparison with a representative group of professionals with whom you have worked, how do you rate the general all-around scholarly/professional ability of the applicant: Outstanding Good Average Below average Not recommended
Comments:
How would you rate the applicant's potential success in graduate programs while attending Peru State College? *

How would you rate the applicant's potential success in graduate programs while attending Peru State College? Outstanding Good Average Below Average Not recommended
Confirmation Required Below

If you would like to share additional information, please contact our Graduate Programs Office at 1.800.742.4412, option 4 or via email at GraduatePrograms@Peru.edu.
Thank you!
Reference Name Reference Name * First Last
Employer/Position *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Email *
May we contact you should we have any questions? *

May we contact you should we have any questions? Yes No
If Yes, please specify the best method of contact:

If Yes, please specify the best method of contact: Email Telephone
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I certify that all information in the reference is true and correct to the best of my knowledge.

Peru State College Graduate Programs - Recommendation form

Peru State College Graduate Programs - Recommendation form

Completion Instructions:

Confirmation Required Below

By clicking Submit below