Faculty Recommendation Form (Page 1 of 2)

NURSE EXTERN PROGRAM

Faculty Recommendation Form (page 1 of 2)

Applicant Name (Please print): ______School: ______

TO THE APPLICANT:

The Family Educational Rights and Privacy Act of 1974 and its amendments guarantee students access to their own educational records. Students are permitted to waive their rights of access to recommendations. The following indicates the wish of the applicant regarding this appraisal:

______I waive my right to review this recommendation.

______I do not waive my right to review this recommendation.

Applicant Signature: ______Date: ______

TO THE RECOMMENDER:

We would appreciate your candid appraisal of the applicant’s ability to benefit from the Nurse Extern Program. Please use the tables below. Additionally we would appreciate any comments that you have to offer in the space provided. Thank you for your time!

What is your association with the applicant?

Please initial in the space provided your opinion and experience relative to the personal characteristics of the applicant:
Poor / Average / Good / Superior / No Opinion
Reliability
Motivation
Self-Discipline
Judgment
Self-Confidence
Maturity
Interpersonal Relations
Emotional Stability
Please initial in the space provided your experience/observations with this applicant in the clinical environment:
Never / Rarely / Sometimes / Often / Always
Demonstrates compassion with patients and families
Communicates appropriately with patients, families, and peers
Provides care in a safe and thoughtful manner
Demonstrates the ability to apply critical thinking skills in the clinical area
Arrives to assigned clinical area on time
Attends classes and clinicals as assigned
Seeks out learning opportunities
Takes direction well

NURSE EXTERN PROGRAM

Faculty Recommendation Form (page 2 of 2)

Please comment on your knowledge of the applicant, especially as it relates to the applicant’s interest in pursuit of their career in Nursing and acceptance into the Nurse Extern Program. You may also provide a separate Letter of Recommendation if it is more convenient.

Comments:

______

Overall Recommendation of Applicant:

_____ Strongly recommend

_____ Recommend

_____ Do not recommend

_____ Applicant not suitable at this time for recommendation

_____ Insufficient information to recommend

Name of Recommender (Please print) ______Title ______

University/College Name ______

Contact Address/Email ______

Signature/Initials______Date ______

Faculty Recommendation form must be submitted prior to the application deadline of January 17, 2015 to

Ethel Renew, Workforce Development/Student Services Coordinator, Health Sciences Administration Building

Greenville Health System, 701 Grove Road, Greenville, SC 29605

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