Honors Scholars Program Recommendation Form

To the applicant: Fill in your name and address below, and give this form to a teacher who knows you will and who has taught you in an academic discipline. Also complete the FERPA release form below.

Date:
Applicant: / Tartan ID:
Address: / Phone:
City: / State: / Zip:
Email: / Cell Phone:

To the teacher: The Honors Council would appreciate your candid evaluation of this student as an applicant to the Honors Scholars Program at Sinclair Community College. Fill in the questions below and return this form to the Sinclair Honors Program, SinclairCommunity College, 444 West Third Street, Dayton, OH45402-1460. If you have any questions, please call 937.512.4331, or or

Name:
Title:
Department:
School:
School address:
School phone:
In what course(s) have you taught the applicant?

What are the first words that come to mind to describe the applicant?

Compared to other students, how would you rate this applicant? 1: below average. 2: average. 3: above average. 4: outstanding. 5: one of the best students I’ve ever taught.

Creative thinking12345

Motivation12345

Initiative12345

Written expression of ideas12345

Effective class discussion12345

Please attach a detailed description and evaluation of the student’s academic work, motivation, intellectual ability, and contributions in class or respond to the following questions.

  1. Please comment on the applicant’s attitude toward learning in general, how well he or she synthesized information, and whether he or she is willing and able to consider alternative points of view.
  1. Please comment on any special interest or talents that may distinguish this applicant from others.

Signed: / Date:

Sinclair Honors Program

SinclairCommunity College

444 W Third Street ~ Dayton, OH45402

FERPA RELEASE

Letter of Recommendation

SinclairCommunity College

444 West Third Street

Dayton, Ohio45402

[INSTRUCTIONS and EXAMPLES look like this]

Name of Student (Print Name) (Tartan ID #)

In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), I, the undersigned, hereby authorize ______[instructor / staff name] to write a letter of recommendation in which he/she may reference the following educational records and information:

[list educational records information that will be included, such as grades, GPA, class rank, etc.]

to: [name and address of receiving party provided by student]

Derek Petrey

Sinclair Honors Program

SinclairCommunity College

444 W Third Street

Dayton, OH 45402email:

for the purpose of: [providing arecommendation for employment or scholarship]

I understand further that (1) I have the right not to consent to the release of my education records; (2) I have the right to receive a copy of such records upon request; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to Sinclair Community College, but that any such revocation shall not affect disclosures previously made by Sinclair Community College prior to the receipt of any such written revocation.

□ I waive my right to review a copy of this letter at any time in the future.

□ I do not waive my right to review a copy of this letter at any time in the future.

Student’s SignatureDate

THIS INFORMATION IS RELEASED SUBJECT TO THE CONFIDENTIALITY PROVISIONS OF FERPA AND OTHER APPROPRIATE STATE AND FEDERAL LAWS AND REGULATIONS, WHICH PROHIBIT ANY FURTHER DISCLOSURE OF THIS INFORMATION WITHOUT THE SPECIFIC WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS, OR AS OTHERWISE PERMITTED BY SUCH REGULATIONS.