College of Graduate Studies

CONHS Reference Form

College of Nursing and Health Sciences

Applicant's Information
* Student name:
* Student ID:   ('A' number)
Address:
City:
State:
Zip:
Phone:
Email:
* required information
Evaluator's Information
* First name:
* Last name:
Address:
City:
State:
Zip:
Phone:
* Email:
Job Title:
* required information
Evaluation Please rate applicant on qualities below to the best of your knowledge
Individual characteristic Exceptional Above
Average
Average Below
Average
Capacity for Independent Thinking
Intellectual Ability
Leadership Ability
Motivation to Work
Ability to Work Well with Others
Ability to Express Self Orally
Writing Ability
Emotional Maturity
Likelihood of Success in Graduate Work
Likelihood of Career Success
Problem-Solving Ability
Analytic Ability

How long have you known this applicant?

In what capacity do you know this applicant? Are you his/her co-worker, supervisor, etc.?
What is your working/professional relationship with this applicant?

Please share any additional information about this applicant that might help
us assess potential for success
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Please contact us with any issues or concerns at 361-825-2753, or via email at gradweb@tamucc.edu