Graduate Letter of Recommendation Form

PERSONAL REFERENCE FORM

This form is to be completed by the applicant and the reference and returned to the University of Utah Pharmaceutics.

PART I - To be completed by the applicant

Applicant's Name:_________________________________________________

Graduate Degree Sought:____________________________Semester_______________

Please list any courses taken with the person giving the reference:

Course Number	Course Title	When Taken	Grade Received

□ I do □ Do Not give permission for the above "education record" information to be disclosed to the School of Pharmaceutics as part of the application process.

Please give other personal contacts with the person giving the reference:
_______________________________________________________________________________

□ I waive □ Do not waive my right to have access to this Personal Reference Form

Signature of Applicant

Written permission from the student is required for a letter of recommendation if any information included in the recommendation is part of the "education record" (courses taken, grades, GPA, etc.). If the letter of recommendation is kept on file by the person writing the recommendation, then it becomes part of the student's education record and the student has the right to read it unless he/she has specifically waived that right of access. The only time a written release from the student is not required is if the recommendation is based solely upon personal acquaintance/observation and the letter will not contain any information derived from educational records.

PART II - To be completed by the reference and returned directly to the University of Utah School of Pharmaceutics

1. □ I do □ Do not know the student's academic abilities well enough to give the applicant a recommendation.

2. Please check educational level of representative group with whom the applicant is compared:

□ College Junior □ College Senior

□ First-year Graduate Student □ Advanced Graduate Student

3. Summary Evaluation - Overall scholastic ability: In comparison with a representative group of students in the same field who have had approximately the same amount of experience and training, how do you rate the applicant in general scholarly ability? Please rate the student's academic performance by selecting from the following:

	Truly exceptional	Equivalent to very best you have known
	Outstanding	Comparable to best student in current class; highest 5%
	Good	Ability easily identifiable, but not upper 10%; upper 15%
	Average	Upper 50%
	Not recommended for graduate study

4. Some gifted individuals have mediocre scholastic performance. In your opinion, is the applicant's current scholastic record, as you know it, an accurate index of his/her scholastic ability?

□ Yes, □ No, □ Do not know.

If your answer is "No," please explain briefly, possibly giving consideration to the applicant's performance in independent study or in research participation programs.

5. What is your estimate of the applicant's promise as a graduate student?

6. □ I would □ would not be pleased to have the applicant working under my direction as a □ teaching assistant or □ graduate assistant.

Signature______________________________________________Date______________

Name printed or typed_______________________________________________

Title________________________________________________

Institution_____________________________________________

Address_________________________________________________________________

Please return this form to:

University of Utah Pharmaceutics
c/o Graduate Secretary
30 S. 2000 E., 301 Skaggs Hall
Salt Lake City, UT 84112

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