Reference for Candidacy Form

							
																			Reference for Candidacy Form
												
							Reference Name*						

							Adrian College Student Name *						
Knowledge of Applicant

							Approximately how long have you known the applicant? (years and months)*						

							In what capacity do you know the student*						
Applicant's Promise as a BSW Student
Please rank the following characteristics based on a 10 point scale

Exceptional (10-9), Above Average (8-7), Average (6-5), Below Average (4-3), Poor (2-1), or No Basis for Ranking (NB)

							Writing Ability*						

							Interaction with Work Groups*						

							Knowledge of Agency/ System & Services Offered*						

							Interaction with Public/Clients*						

							Openness to Supervision*						

							Openness to Diversity*						

							Attitude*						

							Motivation*						

							Intellectual Ability*						

							Autonomy*						

							Promptness*						

							Oral Expression*						

							Emotional Maturity*						

							Reliability*						

							Personal Appearance*						
Observation About Applicant

							How do you view this student's strengths and needs?*						

							What is your assessment about this student’s openness to new ideas and willingness to stand up for what s/he believes? How good is this student’s fit?*						
Evaluation Summary

							This student's performance in my contact and experiences with her/him*						

							Recommendation to BSW Program*						

							Signature *						

							Date*						

							First Name*						

							Last Name*						

							Title*						

							Organization*						

							Your Address*						

							City/State/Zip Code of Current Address*						

							Telephone