APPLICANT INFORMATION
to be completed by the student.
Please type or print

Name: Last__________________ First______________________ Middle____________________
Former name(s) on academic records__________________________________________________
Address: Street___________________________________________________________________
City______________________________ State__________________________ Zip____________
Social Security Number:__________________ Intended semester of entry:______________________

Unless specified, applicant will not be granted access to the recommendation. A waiver of such rights is not a condition for admission to Concordia University.
This is to certify that I do not waive the right of access to this file.

Freshman Applicants: Ask a current academic instructor or your guidance counselor to complete this form.

Transfer Applicants: Ask a current or former academic instructor, advisor, employer, supervisor or dean of students to complete this form.

EVALUATION
to be completed by the evaluator

Evaluator: We would appreciate your careful and candid evaluation of the above-named applicant for admission to Concordia University. Your appraisal is important in determining his or her probable success at Concordia. Your comments will not become part of any permanent record.

Please rate the applicant in comparison to other students you have known who have been successful in college. Circle one.

	No Basis	Poor	Below Average	Average	Above Average	Excellent
	0	1	2	3	4	5
ACADEMIC RATING	___________	___________	___________	___________	___________	___________
Academic Achievement	0	1	2	3	4	5
Writing Skills	0	1	2	3	4	5
Speaking Skills	0	1	2	3	4	5
Listening Skills	0	1	2	3	4	5
Intellectual Potential	0	1	2	3	4	5
Disciplined Study Habits	0	1	2	3	4	5
Logical Reasoning	0	1	2	3	4	5
CHARACTER & PERSONALITY
Commitment to Career Goal	0	1	2	3	4	5
Self-confidence	0	1	2	3	4	5
Peer Relationships	0	1	2	3	4	5
Integrity	0	1	2	3	4	5
Concern for Others	0	1	2	3	4	5
Leadership	0	1	2	3	4	5

1. In the space provided below or on letterhead, please evaluate this applicant's personal and academic qualifications. We are especially interested in your comments on personal ability, creative ability, work habits and potential. We welcome any comments which you feel would be relevant.

Signed:______________________________________ Position:_____________________________
Please print your name:_______________________________________ Date:__________________
Phone Number: (_____)___________________________
Length of acquaintance with applicant:__________________________________________________
In what context have you known the applicant?