School of Radiography Letter of Reference
Applicant ____________________________________________________________ The applicant named above is in the process of applying for entrance into the School of Radiography at Marquette General Health System. Personal recommendations are a very important part of the application process and are reviewed carefully by members of the Admission Committee. We are anxious to select those individuals whose accomplishments, personal attributes, and abilities indicate that they have the greatest potential for medical training and provision of health care. Therefore, we ask you to provide a thoughtful and sincere appraisal of this applicant. Your early reply is appreciated. Under the Family Education Rights and Privacy Act, students of the School of Radiography have the right to inspect their files upon request. So that the person completing this letter of reference is assured their response will be held in confidence the following policy is stated:
Letters of reference are removed from the student’s file at the time selections are made and prior to the individual becoming a student. Therefore, this letter of reference will remain confidential.
It may not be possible to thank each individual for completing a reference form. We want you to know however, that we are aware of the time required and are most appreciative of your response.
Yours truly,
JoAnna L. Perucco, M.S., R.T.(R)(M) Marquette General Health System School of Radiography 420 W. Magnetic St. Marquette, MI 49855
Applicant : ________________________________________________________________ Please rate the applicant in the following categories. If you have no basis for evaluation in any category, please select “not applicable”.
1. INDUSTRY Willingness to work, work habits, zeal, perseverance, energetic attention. A. B. C. D. E. F. Little or no effort Seldom completes work Ordinarily completes work Occasionally does extra work Does extra work gladly Not applicable
2. THOROUGHNESS Accuracy, carefulness, definiteness, exactness. A. B. C. D. E. F. Careless work always incomplete Expresses ideas carelessly, inaccurately Work generally completed and reasonably accurate Careful work, accurate Very careful and thorough Not applicable
3. INITIATIVE Intellectual curiosity, original, willingness to attempt new ideas. A. B. C. D. E. F. Never tries anything new Seldom originates any work Sometimes attempts new ideas Often initiates undertakings Marked ability to think for themselves Not applicable
4. RELIABILITY Dependability, good judgement, ability to function without supervision. A. B. C. D. E. F. Dishonest, neglects obligations Often needs supervision At times, must be prompted Usually assumes obligations Thoroughly dependable Not applicable
5. COOPERATION Ability to get along with others, adaptable, tactful, agreeable, cheerful. A. B. C. D. E. F. Disagreeable, antagonistic Slow to respond, not willing to help Fairly well balanced, good control Does well in teamwork Always willing to help others Not applicable
6. EMOTIONAL CONTROL Poise, moodiness, temperament. A. B. C. D. E. Very poor control of emotions Occasionally loses self control Fairly well balanced, good control Well balanced, poise Not applicable
7. INTELLECTUAL CAPACITY Natural ability to succeed in academic and clinical effort. A. B. C. D. E. F. Very slow to learn Needs to make extra effort to keep up Average intelligence Quick to grasp subject Brilliant, highest fifth Not applicable
8. RECOMMENDATION A. B. C. D. E. Not recommended Recommended with reservations Recommended Recommended with confidence Highly recommended
9. ADDITIONAL COMMENTS Please provide any descriptive comments that will aid in providing a complete picture of the applicant’s abilities and potential as a student and health care professional.
Evaluator’s Name _________________________________________ Date __________ Professional relationship to applicant_________________________________________ Length of time of relationship ______________________________________________
Revised 1/07