Recommendation Form

From NON-RELATIVE

Mr. Ms. ______is applying for admission to the BSW Program at The University of Southern Mississippi. The applicant and BSW Program Admissions committee appreciate your completing this form and returning it at your earliest convenience.

I hereby: Do Do Not waive my rights of access to any and all letters of statements of recommendation which may be submitted by ______(applicant must specify name of person submitting recommendation before sending/giving form to that person) in connection with my application to the Baccalaureate Social Work Program of The University of Southern Mississippi.

______

Signature of Applicant Date Applicant’s ID#

Knowledge of the Applicant

Approximately how long have you known the applicant? Years _____ Months _____

How well do you know the applicant? Casually Well Very well

Relative Rating of the Applicant

Among college students, where would you rank this applicant in terms of his/her intellectual ability?

Lowest 25% / Middle 25% / Upper 25% / Upper 10% / Upper 5% / Upper 1%

Applicant’s Promise as a BSW Student (Please rate by numeric values)

Exceptional
(10-9) / Above Average
(8-7) / Average
(6-5-4) / Below Average
(3-2) / Poor
(1-0) / No Opportunity to Observe
Interaction with employees
Interaction with client/public
Writing ability
Oral expression
Analytical ability
Openness to supervisor
Knowledge of agency/work structure
Knowledge of services offered
Emotional maturity
Resourcefulness
Originality
Motivation to contribute
Enthusiasm
Carrying out instruction/tasks
Autonomy
Promptness
Personal appearance
Observation About Applicant
Please express your views of the student’s strengths and needs (areas of improvement).




In your opinion, how open is the new student to new ideas and how willing to stand up for what he/she believes.

NON-RELATIVE SUMMARY EVALUATION

Recommendation To BSW Program:
Highly recommend Recommend Recommend with reservation Do not recommend

Signature Date
Name
Title
Organization
Address
City/State/Zip
Phone
Please mail or fax this recommendation form to:
The University of Southern Mississippi
Baccalaureate Social Work Program
Attention: BSW Coordinator OR FAX: 601 266 4167
118 College Dr.#5114
Hattiesburg, MS 39406-5114

Rev. 6/16