This is one of three total references that School of Counseling applicants must have completed.  The reference should be completed by someone that can address the applicants either academic or professional characteristics.  Ideally it should be a professor, or supervisor.

To the Reference: The student is applying for admission to Richmont Graduate University and is asking you to furnish a reference.  The admissions committee would appreciate your frank evaluation of the applicant.  This form should take you no more than 5 minutes to complete.

Academic/Professional Reference

Richmont Applicant Information

RGU Applicant First Name

RGU Applicant Last Name

How long have you known the applicant?

How well do you know the applicant and in what context?

 Characteristics of Applicant

	Unusually High	Above Average	Average	Below Average	Unable To Judge
Academic/professional ability
Creative, innovative thinking
Capacity for objective evaluation of self
Empathic capacity
Ability to work independently
Capacity to handle stress
Open-mindedness, tolerance for differences
Energy level at work or in class
Commitment to counseling

Additional Comments

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Does the applicant have any personality characteristics that would interfere with work in the counseling field?

Please check the items below to answer this question.

	Definitely No	Possibly Yes	Definitely Yes	Unable to Judge
Anxious, fearful
Dependent
Low self-esteem, unusual need for approval
Manipulative
Hostile, angry
Shy, sensitive to criticism
Pushy, aggressive
Impulsive, hasty

Since you indicated "Definitely Yes" on at least one of the above, please tell us if it is minor, moderate, or significant.  Also, please provide additional details so we are aware

What degree of success do you anticipate for the applicant in graduate school?

Overall Recomendation

Rate the applicant's potential for counseling work

ExcellentGoodFairPoor Unknown

Indicate the strength of your overall endorsement of the applicant

Highly RecommendRecommendRecommend with some reservationsDo not Recommend

Any additional comments or information regarding the applicant

About You the Reference

Your First Name

Your Last Name

Address & Map

Street Address City/State Zip / Postal Code Business/Organization

Phone

Email

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