INDIANA CHILDWELFARETRAUMA FELLOWSHIP

NCWWIPROGRAM

RECOMMENDATION FORM

TOTHEAPPLICANT:

Name (PRINT):------

AspartoftheapplicationprocessforthestipendprogramthroughtheIndianaChildWelfareScholarsProgramyoumustsubmit three(3)professionaloracademicreferences. Pleaserequestreferencestatementsfromthree(3)personswhohaverecent

knowledgeabout youracademicorprofessionalqualifications. Askeachofthemtosendthereferencestatementbacktoyouinasealedenvelopeaftersigningacrosstheseal.

Submitthoseunopenedletterstogetherwithyourapplication. Referencesfromfamilymemberswillnotbeaccepted.Include,ifpossible,a)areferencefromanemployer;b)areferencefromasupervisorfromvolunteerwork;andc) areferencefromone faculty member. YOUR SIGNATURE ISREQUIRED ON THISFORM.

NOTICEOFWAIVER

IamawareofmyrightsundertheFamilyEducationalRightsandPrivacyActof1974tohaveaccesstolettersofrecommendationwrittenonmybehalf. IalsounderstandthatbysubmittingthisletterofrecommendationwithmyapplicationpacketitbecomesthepropertyoftheIndianaChildServicesEducationProgramandthereforemyrightofaccessislimitedtoviewingthedocumentonlyattheschoolandIwillnotbeallowedtoobtainacopyoftheletterfromtheschool. Ialsounderstandthatmyabilitytoviewthese documentsiscontingentuponmybeingadmittedintotheIndianaChildServicesEducationProgram.

ItismydesirethatthisletterbewritteninconfidenceandIwaivemyrightofaccesstoreadthisletter.

IwishtoretainmyrighttoreadthisdocumentonceIhavebeenadmittedtotheIndianaChildServicesEducationProgram.

Signature Date

Youmustcheckoneoftheaboveoptions,sign,anddatethiswaiverifthisletteristobeincluded inyourfile.Failuretocomplywillwaivetherightoftheapplicanttoreadthisletter

TOTHEREFERENCE:YouhavebeenaskedtocompleteanevaluationontheabovenamedpersonwhoisapplyingforadmissiontotheIndianaChildWelfareScholars Program. Yourcandidopinionwillbeofgreatassistancetousinevaluatinghis/herapplication. Yourcommentswillbeconfidentialiftheapplicanthaswaivedtherighttoreview. Applicantswhoarenotapprovedfortheprogramhavenoaccesstotheirfile.

TohelptheadmissionsCommitteemakeaninformeddecisionontheapplicant'ssuitabilityfortheprogram,pleaseanswerthefollowingquestions.

1.Howlongandinwhatcapacityhaveyouknowntheapplicant?------

2.Pleaseevaluatetheapplicantineachofthefollowingareas:

LimitedAdequateHighCan'tJudge

LevelofMaturityAndEmotionalStability

UnderstandingofSelf

Abilitytorespect

andworkwithdifferencesinpeople(i.e.race,class,culture,ethnicity,sexualorientation)

Responsible

behavior(attendance,punctuality,etc)_

Oralcommunicationskills

Writtencommunication skills

Abilitytoworkwithothers

Abilitytoacceptconstructivefeed­back

23456

3.Inyouropinion,whataretheapplicant'sprimarystrengths?

4.Inyouropinion,whataretheapplicant'sweaknesses?

S.Whatlevelofcriticalthinkingskillshave youobservedintheapplicant?

6.Iwould:

---Recommendwithenthusiasm

---Recommend

---Recommendwithreservation

---Notrecommend

Signature:_Date:------

Name(printortype)_

Organization:------Phone#:-----

INDIANACHILDWELFARESCHOLARS/NCWWIEDUCATIONPROGRAMDEPARTMENT OFCHILDSERVICES

RECOMMENDATION FORM

TOTHEAPPLICANT:

Name(PRINT):_

Aspartof theapplicationprocessforthestipendprogramthroughtheIndianaChildWelfareScholarsProgramyoumustsubmitthree(3)professionaloracademicreferences.Pleaserequestreferencestatementsfromthree(3)personswhohaverecent

knowledgeaboutyouracademicorprofessionalqualifications. Askeach of themtosendthereferencestatementbacktoyouinasealedenvelopeaftersigningacrosstheseal.

Submitthoseunopenedletterstogetherwithyourapplication. Referencesfromfamily memberswillnotbeaccepted.Include,if possible,a)areferencefromanemployer;b)areferencefromasupervisorfromvolunteerwork;andc) areferencefromonefacultymember. YOUR SIGNATURE ISREQUIRED ONTHISFORM.

NOTICEOFWAIVER

Iamawareof myrightsundertheFamilyEducationalRightsandPrivacyActof1974tohaveaccesstolettersof recommendationwrittenonmybehalf. IalsounderstandthatbysubmittingthisletterofrecommendationwithmyapplicationpacketitbecomesthepropertyoftheIndianaChildServicesEducationProgramandthereforemyrightofaccessislimitedtoviewingthedocumentonlvat theschoolandIwillnotbeallowedtoobtainacopyoftheletterfromtheschool. IalsounderstandthatmyabilitytoviewthesedocumentsiscontingentuponmybeingadmittedintotheIndianaChildServicesEducationProgram.

ItismydesirethatthisletterbewritteninconfidenceandIwaivemyrightofaccesstoreadthisletter.

IwishtoretainmyrighttoreadthisdocumentonceIhavebeenadmittedtotheIndianaChildServicesEducationProgram.

Signature Date

Youmustcheckoneof theaboveoptions,sign,anddate thiswaiverifthisletteristobeincludedinyourfile.Failuretocomplywillwaivetherightoftheapplicanttoreadthisletter

TOTHEREFERENCE:Youhavebeenaskedtocompletean evaluationontheabovenamedpersonwhoisapplyingforadmission totheIndianaChildWelfareScholarsProgram. Yourcandidopinionwillbeofgreatassistancetousin evaluatinghis/herapplication. Yourcommentswillbeconfidentialiftheapplicanthaswaivedtherighttoreview. Applicantswhoarenotapprovedfortheprogramhavenoaccesstotheirfile.

TohelptheadmissionsCommitteemakeaninformeddecisionontheapplicant'ssuitabilityfortheprogram,pleaseanswerthefollowingquestions.

1.Howlongandinwhatcapacityhaveyouknowntheapplicant?_

2.Pleaseevaluatetheapplicantineachof thefollowingareas:

LimitedAdequateHighCan'tJudge

LevelofMaturity AndEmotional Stability

UnderstandingofSelf

I23456

Abilitytorespect

andworkwithdifferencesinpeople(i.e.race,class,culture,ethnicity,sexualorientation)

Responsible

behavior(attendance,punctuality,etc)_

Oralcommunicationskills

Writtencommunicationskills

Abilitytoworkwithothers

Abilitytoacceptconstructivefeed­back

3.Inyouropinion,whataretheapplicant'sprimarystrengths?

4.Inyouropinion,whataretheapplicant'sweaknesses?

5.Whatlevelofcriticalthinkingskillshaveyouobservedintheapplicant?

6.Iwould:

---Recommendwithenthusiasm

---Recommend

---Recommendwithreservation

---Notrecommend

Signature:_Date:------

Name(printortype)_

Organization:------Phone#:-----

INDIANACHILDWELFARESCHOLARS/NCWWIEDUCATIONPROGRAMDEPARTMENTOFCHILDSERVICES

RECOMMENDATIONFORM

TOTHEAPPLICANT:

Name(PRINT):------

AspartoftheapplicationprocessforthestipendprogramthroughtheIndianaChildWelfareScholarsProgramyoumustsubmit three(3)professionaloracademic references. Pleaserequestreferencestatementsfromthree(3)personswhohaverecent

knowledgeaboutyouracademicorprofessionalqualifications. Askeachofthemtosendthereferencestatementbacktoyouinasealedenvelopeaftersigningacrosstheseal.

Submitthoseunopenedletterstogetherwithyourapplication. Referencesfromfamilymemberswillnotbeaccepted.Include,ifpossible,a)areferencefroman employer;b)areferencefromasupervisorfromvolunteerwork;andc) areferencefromonefacultymember. YOUR SIGNATUREISREQUIRED ONTHISFORM.

NOTICEOFWAIVER

IamawareofmyrightsundertheFamilyEducationalRightsandPrivacyActof1974tohaveaccesstolettersofrecommendationwrittenonmybehalf. Ialsounderstandthatbysubmittingthisletterofrecommendationwith myapplicationpacketitbecomesthepropertyoftheIndianaChildServicesEducationProgramandthereforemyrightofaccessislimitedtoviewingthedocumentonlyattheschooland Iwillnotbeallowedtoobtainacopyoftheletterfromtheschool. Ialsounderstandthatmyabilitytoviewthesedocumentsis contingentuponmybeingadmittedintotheIndianaChildServicesEducationProgram.

ItismydesirethatthisletterbewritteninconfidenceandIwaivemyrightofaccesstoreadthisletter.

IwishtoretainmyrighttoreadthisdocumentonceIhavebeenadmittedtotheIndianaChildServicesEducationProgram.

Signature

Date

You mustcheckoneoftheaboveoptions,sign,anddatethiswaiverifthisletteristobeincludedinyourfile.Failuretocomplywillwaivetherightoftheapplicanttoreadthis letter

TOTHEREFERENCE:YouhavebeenaskedtocompleteanevaluationontheabovenamedpersonwhoisapplyingforadmissiontotheIndianaChildWelfareScholarsProgram. Yourcandidopinionwillbeof greatassistancetousinevaluatinghis/herapplication. Yourcommentswillbeconfidentialifthe applicanthaswaivedtherighttoreview. Applicantswhoarenotapprovedforthe programhavenoaccesstotheirfile.

TohelptheadmissionsCommitteemakeaninformeddecisionontheapplicant'ssuitabilityfortheprogram,pleaseanswerthefollowingquestions.

1.Howlongandinwhatcapacityhaveyonknowntheapplicant?------

2.Pleaseevalnatetheapplicantineachofthefollowingareas:

LimitedAdequateHighCan'tJudge

Levelof Maturity AndEmotionalStability

UnderstandingofSelf

Abilitytorespect

andworkwithdifferences inpeople(i.e.race,class, culture,ethnicity,sexualorientation)

Responsible

behavior(attendance, punctuality,etc)_

Oralcommunication skills

Writtencommunicationskills

Abilitytowork withothers

Abilitytoacceptconstructivefeed­back

23456

3.Inyonropinion,whatare theapplicant'sprimarystrengths?

4.Inyouropinion,whataretheapplicant's weaknesses?

5.Whatlevelofcriticalthinkingskillshaveyouobservedintheapplicant?

6.Iwould:

---Recommendwithenthusiasm

---Recommend

---Recommendwithreservation

---Notrecommend

Signature:_Date:------

Name(printortype)_

Organization:------Phone#:-----