Letter of Reference Request Humboldt State University Department of Psychology Master’s of Arts in Psychology (Counseling) Emphasis in Marriage and Family Therapy Applicant Section Please complete this section and deliver or mail this form to your referee. Please ask your referee to return this form and their letter to the Graduate Secretary, Department of Psychology, Humboldt State University, Arcata, CA 95521. Applicant’s Name: I waive my right to access this letter of reference I do not waive my right to access this letter of reference Signature:____________________________________________ Date:___________ Reference Section The admissions committee would appreciate your honest evaluation of the applicant. How long have you known the applicant and in what capacity?_____________________ _______________________________________________________________________ Please provide a ranking of the applicant for the following dimensions and please provide a letter (on letterhead) reflecting your evaluation of the applicant’s strengths, weaknesses and potential as a graduate student in an application-based Counseling/MFT Program.
Top 1% Interpersonal Skill Intellectual Ability Oral Communication Writing Ability Motivation Level Organization
Emotional Maturity
Top 5%
Top 15%
Top 25%
Top 50%
N/A
Clinical Promise
Referee’s Name (Please Print) Referee’s Signature_________________________________________ Date__________ Referee’s Institutional Affiliation/Title________________________________________