HomeHealth SciencesNursing ProgramRN-BSN ProgramRN-BSN Confidential Recommendation BSN CONFIDENTIAL RECOMMENDATION FORM Applicant Applicant Name Dixie ID Evaluator You have been chosen as a reference for the applicant for the Dixie State University RN to BSN Program. We are particularly interested in your appraisal of the applicant’s abilities and potential for education in a rigorous online program. Circle the number that is most characteristic of the applicant. Make any additional comments that you feel would be helpful in our evaluation. 1=Unremarkable 2=Below Average 3=Average 4=Above Average 5=Outstanding ​ Problem Solving Identifies and solves problems quickly and decisively. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Sense of Responsibility Completes tasks and duties, honors commitments, accountable. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Attitude Projects positive demeanor and attitude toward life, school, job, etc. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Caring Shows consistent, genuine, non-judgmental concern and care for the well-being of others. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Motivation Demonstrates preparation and interest in continuing high standard of performance. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Professional Appearance Meets expectations of good grooming and professional nursing image. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Communication Skills Connects effectively and thoughtfully with others using open communication. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Integrity/Confidentiality Demonstrates honesty, exhibits trustworthy and ethical behavior. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Interpersonal Relationships Demonstrates cooperation, fairness, respect, civility, collaboration, and patience. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Reliability Attendance and punctuality habits support required performance. 1 - Unremarkable 2 - Below Average 3 - Average 4 - Above Average 5 - Outstanding Overall Recommendation I do not recommendI recommendI highly recommend Comments Evaluator Information First Name Last Name Title Length of time you have known applicant Capacity you have known applicant Email Address Please use a work or university email (you will receive a copy of this form) Phone Number
