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PERSONAL REFERENCE
REQUEST
Professor or
Advisor Recommendation
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THIS REFERENCE SHOULD BE COMPLETED BY A FACULTY MEMBER OR ADVISOR. IN ORDER TO COMPLETE THIS
REQUEST, FILL IN THE APPLICANT INFORMATION BELOW AND FORWARD TO THE PERSON
COMPLETING THE EVALUATION. THE EVALUATION SHOULD BE
MAILED DIRECTLY TO THE ADMISSIONS OFFICE, HANOVER COLLEGE P.O. BOX
108, HANOVER, IN 47243. IF YOU HAVE NOT RECENTLY ATTENDED A COLLEGE
OR UNIVERSITY, A LETTER OF RECOMMENDATION FROM AN EMPLOYER OR PASTOR MAY
REPLACE THIS FORM.
APPLICANT
I AUTHORIZE APPROPRIATE OFFICIALS TO RELEASE THE INFORMATION
REQUESTED TO HANOVER COLLEGE.
| LEGAL NAME ________________________________________________________________________________________________________________________________________________ |
|
LAST |
FIRST |
MIDDLE |
| SOCIAL SECURITY NUMBER ___ ___ ___ - ___ ___ - ___ ___ ___ ___ | EMAIL __________________________________________________________________ |
INSTITUTION _________________________________________________________________________
DATES ATTENDED ______________________
SIGNATURE __________________________________________________________________________
DATE ___________________________________
EVALUATOR
WE WOULD APPRECIATE YOUR CANDID EVALUATION OF THIS STUDENT'S
ABILITY TO SUCCEED AT HANOVER. WHEN COMPLETE, MAIL TO THE ADMISSION
OFFICE, HANOVER COLLEGE, P.O. BOX 108, HANOVER, IN 47243.
HOW LONG HAVE YOU KNOWN THE APPLICANT? _________________________________________________________________________________
| INDICATE WHETHER YOUR RESPONSES TO THIS INQUIRY
ARE BASED ON: |
RECORDS AND REPORTS |
CLOSE ACQUAINTANCE WITH STUDENT |
|
CASUAL CONTACTS AND OBSERVATIONS |
DIRECT COUNSELING CONTACTS |
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| TO YOUR KNOWLEDGE HAS THE STUDENT BEEN: |
| ON SCHOLASTIC PROBATION? |
YES |
NO |
| ON DISCIPLINARY PROBATION? |
YES |
NO |
| RESPONSIBLE FOR DISRUPTIVE OR IRREGULAR BEHAVIOR? |
YES |
NO |
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IS THIS STUDENT ELIGIBLE TO RETURN TO YOUR INSTITUTION
IN GOOD STANDING?
YES
NO
N/A
WHY DID (WILL) THIS STUDENT LEAVE YOUR INSTITUTION?
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How would you
rate the applicant
in terms of: |
No basis for judgement |
Poor |
Below Average |
Average |
Above Average |
Outstanding |
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| Motivation to study |
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| Self-discipline |
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| Emotional maturity |
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| Leadership ability |
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Please write what you believe is important about this student, including a description of his or her academic and personal characteristics. We are particularly interested in information which will help us differentiate this applicant from others, as well as measure potential for success at Hanover College.
| I recommend this student: |
With reservations |
Fairly strongly |
Strongly |
Enthusiastically |
Signature ________________________________________________ Date ___________________________
Printed Name __________________________________________ E-mail ____________________________
Position or Title ___________________________ Office Telephone
______/___________________________
Institution _______________________________________________________________________________
Confidentiality: We value your comments and
ask you to complete this form in the knowledge that it will be used in
the admissions process and does become part of the student's record while
attending Hanover College.
Hanover College does not discriminate on the basis
of race, creed, color, national origin, sex, marital status, age, sexual orientation or physical disability in its educational programs or activities.