ࡱ> bea_ bjbjzz *hB\B\%ff8*$N$r|Z#4W$" 4[\Rr0g#`g#g#TsL6,!sss`sssg#sssssssssf> : CENTRAL CONNECTICUT STATE UNIVERSITY Department of Counseling and Family Therapy 1615 Stanley Street, New Britain, CT 06050 RECOMMENDATION FORM APPLICANT: Please fill in the personal data information below with your name and address. NAME: ________________________________________TELEPHONE: ________________ ADDRESS: __________________________________________________________________ PROGRAM APPLYING FOR:  FORMCHECKBOX  PROFESSIONAL & REHABILITATION  FORMCHECKBOX  SCHOOL COUNSELING COUNSELING  FORMCHECKBOX  MARRIAGE & FAMILY THERAPY  FORMCHECKBOX  STUDENT DEVELOPMENT IN HIGHER ED ** Waiver: I hereby waive my right to inspect this letter of recommendation.  FORMCHECKBOX  Yes  FORMCHECKBOX  No Applicants Signature: ___________________________________________ Date: _________________ EVALUATOR The above named applicant is applying for admission to graduate studies in Counseling and has given your name as a reference. We ask you to use this form for your recommendation. We will appreciate your appraisal of the applicants personal qualities including motivation, academic skill level, ability to express him/herself orally and in writing, overall reliability, and commitment to the helping professions. Careful and candid discrimination between strong and limited characteristics is more helpful than routine praise. Please take as much space as you require using additional sheets of paper if you desire. Thank you for your help. ** As required by the Family Education Rights Act of 1974, a registered student may reserve the privilege of viewing this recommendation form. Thus, you should consider this evaluation to be non-confidential. ** Please make a narrative statement here: Continued on back page RECOMMENDATION FORM (continued) INSTRUCTIONS: Please rate the applicant on the qualities listed below by placing a check mark to the right of those you feel qualified to judge. Use as your standard of comparison other graduate students or professionals in this field. CHARACTERISTIC:Lower 50%Upper 50%Upper 25%Upper 10%Upper 5%No Basis for JudgementAcademic PotentialWritten Expression of IdeasOral Expression of IdeasDependabilityUnderstanding of Human BehaviorSelf-MotivationPersonal EnthusiasmPatienceAbility to Work CooperativelyAbility to Express Feelings AppropriatelyAbility to Deal With ConflictAware of Impact of Self on OthersWillingness to articulate/demonstrate personal convictionsInterest in Further Personal GrowthUses Feedback From Others ConstructivelyAble to Accept Personal ResponsibilityDemonstrates Ethical BehaviorDemonstrates sensitivity to and respect for the needs and feelings of othersRespects and Appreciates Individual Differences Professional Success Thus Far REFERENCE NAME __________________________________________________________________ PRESENT POSITION __________________________________________________________________ ADDRESS ______________________________________________TELEPHONE _________________ RELATION TO APPLICANT ____________________________________________________________ HOW WELL AND FOR HOW LONG HAVE YOU KNOWN THE CANDIDATE? _________________ Please indicate the strength of your overall impression of the applicants academic promise and capacity to become an effective counselor.  FORMCHECKBOX  Outstanding  FORMCHECKBOX  Above average  FORMCHECKBOX  Satisfactory  FORMCHECKBOX  Marginal _____________________________________________________________________________________ SIGNATURE DATE Thank you for your assistance. Please place this completed form in an envelope, seal it, sign the envelope across the seal, and return it to the applicant, or mail it directly to CCSU, Department of Counseling and Family Therapy, 1615 Stanley Street, New Britain, CT 06050.     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