Undergraduate - Nursing Reference Report

This form is to be completed by the reference writer. Due to federal legislation giving students access to educational records, we cannot guarantee the confidentiality of this document unless the applicant has signed a waiver. Please complete this document to the best of your ability.

If you have any questions please contact the undergraduate admissions office at admission@sunypoly.edu or by phone at 315-792-7500

Applicant First Name:

Applicant Last Name:

Reference First Name

Reference Last Name

Reference Email Address

Confirm Reference Email

Please rate the applicant compared to his/her peers on the following:

In what capacity do you know the applicant?

Please explain

How long have you known the applicant?

How well do you know the applicant?

Very well

Moderately well

Slightly

How well do you know the applicant?

What are the applicant's primary areas of strength?

What are the applicant's primary areas of weakness?

What is your overall evaluation of the applicant’s ability for success in graduate school?

Undergraduate - Nursing Reference Report

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