If you see this message, your browser doesn't have the features needed to view this form, nor does it support the JavaScript needed to redirect it to an alternate page.

The University of Texas School of Nursing at Houston
Applicant Letter of Reference for Doctoral Programs
Form Image
Last Modified Date:
04/28/2006
Instructions to the applicant:
Complete items 1-3, print the form, sign it, then send it to the recommender for completion. The finished form and letter can be sent in a sealed envelope with your application for admissions or mailed directly to this address: Office of the Registrar: The University of Texas Health Science Center at Houston, P.O. Box 20036, Houston, Texas 77225-0036.

NOTE: Make sure your recommender is aware of the application deadline you are trying to meet.
1. Provide 10 Digit Student ID or US Social Security Number - Information is not required.**
2. Projected entrance year into the program:
3. Name (last, first, middle) - as it appears on the application for admission.
**Disclosure of your Social Security Number (“SSN”) is requested for the student records system at The University of Texas Health Science Center at Houston (the “University”) and for compliance with Federal and State reporting requirements. Although an SSN is not required for admission to the University, failure to provide your SSN may result in delays in processing your application or in the University’s inability to match your application with transcripts, test scores, and other materials. Student SSNs are maintained and used by the University for financial aid, internal verification, and administrative purposes, and for reports to Federal and State agencies as required by Federal and State law. Federal law requires hospitals that incur indirect costs for graduate medical education programs and hospitals that receive Medicare payment for direct graduate medical educational activities to identify residents by SSN. The privacy and confidentiality of student records is protected by Federal and State law and the University will not disclose your SSN without your consent for any other purposes except as allowed by law. With few exceptions, an individual student is entitled upon request to be informed about the information the University collects about the student, to receive and review the information, and is entitled to have the University correct any incorrect information about the student.
Check one of the following statements:
I understand that federal legislation provides me with a right of access to his recommendation after I matriculate; while this right may be waived, no school or person can require me to waive this right.
Applicant's Signature
Date

Instructions for the Recommender - The above named applicant is requesting that you serve as a reference for his/her application to The University of Texas School of Nursing at Houston. To assist us in evaluating his/her application, please complete this form and return it to the address noted at the top of this page. All completed forms will be treated confidentially.

Because this is an applicant-managed process, you should seal the completed recommendation in an envelope, sign the envelope flap, and return it to the applicant The applicant will forward it to the doctoral program with his/her application packet. All completed forms will be treated confidentially.

Please enclose a letter or write in the space below your assessment of the applicant's strengths, qualities and skills in relation to his/her scholarly potential and promise for advanced and original work. Indicate areas in which this applicant will need to strengthen skills or abilities. If possible, provide specific examples of the applicant's strengths and weaknesses.

4. Please rank the applicant on the following areas:

  No basis for judgement Below Average (Lowest 40%) Average (Middle 20%) Good
( Next 15%)
Very Good
(Next Highest 15 %)
Outstanding (Highest 10 %) Truly Exceptional
Critical thinking and reasoning ability              
Capacity for independent and original thinking              
Leadership ability              
Effectiveness of written communication              
Effectiveness of oral communication              
Self-direction and initiative              
Skill in handling problems constructively              
Ability to work cooperatively with others              
Emotional maturity              
Tolerance of ambiguity              
Reliability and conscientiousness              
Clinical expertise and interest              
Perseverance in pursuing goals              
Personal and intellectual integrity              
Potential as a researcher              
5. How long have you known this applicant? Include dates.
7. Where would you place the applicant on the following scale?
6. In what capacity have you known the applicant?
Name (Type or Print)
Signature
Position or Title
Institution
Address - Line1
Address - Line 2 (if needed)
Phone Number