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Page 1: rid School of Nursing Masters or Doctoral Programs … . School of Nursing Masters or Doctoral Programs (PhD or DNP) Candidate’s Name_____

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School of Nursing Masters or Doctoral Programs (PhD or DNP)

Candidate’s Name____________________________________________________________________________________________ (Printed) Last First Middle Last Four Digits SSN # NOTE: You may attach additional pages for text if necessary with candidate’s full name on each.

Intellectual potential

Leadership potential

Creativity/imagination

Communication skills: oral

Communication skills: written

Ability to work with others

Demonstrated Professionalism

Motivation for advanced study

Overall Promise

No basis for judgment

Below Average

Average Good Excellent Top10%of all known

Outstanding Top 2 % of all known

Signature______________Date_______ Name __________________________ Title ___________________________ Employer _______________________ Mailing Address _________________________ _________________________ _________________________ Phone __________________________ Email __________________________ Relationship to applicant and how long known:

Applicant

Additional comments (required for PhD and DNP references):

Return to the Whetten Graduate Center, 438 Whitney Road Ext, Unit 1006, Storrs, CT 06269-1006 Phone: 860-486-3617 Fax: 860-486-6739 [email protected]

Page 2: rid School of Nursing Masters or Doctoral Programs … . School of Nursing Masters or Doctoral Programs (PhD or DNP) Candidate’s Name_____

Directions:

1. Three letters of reference are required 2. Applicant is responsible to provide the form to the person providing the reference (it may

be downloaded from the UCONN SON web site) 3. Hard copy to the Graduate School (address on form) by the writer 4. Applicant may contact specific Track Coordinator in the School of Nursing for queries

concerning sources of letters of reference 5. All PhD or DNP references must be accompanied by a narrative reference using this form and

additional pages as needed.