Disability Services
4400 University Drive, MS 5C9
Student Union Building 1, Suite 2500
Fairfax, VA 22030
Phone: (703) 993-2474
Fax: (703) 993-4306
TTY: (703) 993-2476
Email:
Mason Autism Support Initiative
Recommendation Form

The information on this form will be used as part of the application process for determining acceptance in the Mason Autism Support Initiative (MASI) at George Mason University. The MASI program offers individualized, comprehensive social and academic supports to motivated GMU students with autism spectrum disorder in order to guide them through the initial transition into university life, and assist them in building skills necessary to have a successful student experience and enter the workforce after graduation. Thank you for your help in providing valuable information to assist the MASI team in making this decision.This is a confidential recommendation.

Date: ______

Name of applicant: ______
Name of person completing form: ______
In what capacity and for how long did you work with the applicant? ______

Are you willing to be contacted in regards to the student? Yes ____ No____

If yes, please provide phone number and email ______

Please provide our team with information on any notable strengths or difficulties in the following areas (Feel free to type your responses on a separate page if you require more room or prefer a different method of submitting your answers):

Academic Performance: ______

______

______

Classroom Conduct: ______

______

______

Peer Relations: ______

______

______

Please rate the applicant in regard to the following:

Superior / Above
Average / Average / Below
Average / Unable to Judge
Time management / □ / □ / □ / □ / □
Organization / □ / □ / □ / □ / □
Analytical skills / □ / □ / □ / □ / □
Study skills / □ / □ / □ / □ / □
Oral expression / □ / □ / □ / □ / □
Test performance / □ / □ / □ / □ / □
Preparation for class / □ / □ / □ / □ / □
Class participation / □ / □ / □ / □ / □
Assignment completion / □ / □ / □ / □ / □
Following directions / □ / □ / □ / □ / □
Following rules / □ / □ / □ / □ / □
Interpersonal skills / □ / □ / □ / □ / □
Group/partner work / □ / □ / □ / □ / □
Reading skills / □ / □ / □ / □ / □
Writing skills / □ / □ / □ / □ / □
Math skills / □ / □ / □ / □ / □
Reasoning skills / □ / □ / □ / □ / □
Abstract thinking / □ / □ / □ / □ / □
Handling frustration / □ / □ / □ / □ / □
Concentration / □ / □ / □ / □ / □
Motivation / □ / □ / □ / □ / □
Independence / □ / □ / □ / □ / □
Self-confidence / □ / □ / □ / □ / □
Self-advocacy / □ / □ / □ / □ / □
Maturity & judgment / □ / □ / □ / □ / □
Accepting responsibility / □ / □ / □ / □ / □

School/Class Attendance (circle one):

Number of Absences:FrequentOccasionalSeldomRarely

Number of Tardies:FrequentOccasionalSeldomRarely

What areas would you recommend this applicant receive support in the college curriculum/environment?

______
______
______
______
______
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Additional comments: Please provide any further information you feel would be useful to us in considering this applicant:

______
______
______
______
______

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Please return this completed form to Disability Services by mail at the address above, or by email to .If you have questions, please contactDisability Services at 703-993-2474, or .