This form is to be completed by the person providing the professional reference. Applicants: You can send the URL of this page to your references for them to complete the form. Name of Applicant First Last Name of Evaluator First Last Title Occupation PhoneEmail How long have you known this applicant? In what capacity do you know this applicant? Reference RatingsAdaptability Excellent Good Average Below Average Fair Not Observed Conflict resolution Excellent Good Average Below Average Fair Not Observed Ethics Excellent Good Average Below Average Fair Not Observed Intellectual ability Excellent Good Average Below Average Fair Not Observed Integrity Excellent Good Average Below Average Fair Not Observed Interpersonal relations Excellent Good Average Below Average Fair Not Observed Judgment Excellent Good Average Below Average Fair Not Observed Leadership Excellent Good Average Below Average Fair Not Observed Oral communication Excellent Good Average Below Average Fair Not Observed Organization Excellent Good Average Below Average Fair Not Observed Professional demeanor Excellent Good Average Below Average Fair Not Observed Reaction to criticism/feedback Excellent Good Average Below Average Fair Not Observed Reliability Excellent Good Average Below Average Fair Not Observed Self-awareness Excellent Good Average Below Average Fair Not Observed Stress management Excellent Good Average Below Average Fair Not Observed Team building Excellent Good Average Below Average Fair Not Observed Time management Excellent Good Average Below Average Fair Not Observed Written communication Excellent Good Average Below Average Fair Not Observed Overall score Excellent Good Average Below Average Fair Not Observed Time management Excellent Good Average Below Average Fair Not Observed Would you recommend this applicant for admission into a nurse practitioner residency program? Yes No Letter of RecommendationUpload Letter of RecommendationMax. file size: 300 MB.