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Reference - Form 1 TR

The document is a reference form for a graduate program applicant named Yassine Fanane. It contains sections for the applicant's contact information, proposed area of study, and a waiver statement. The rest is to be completed by Thomas Rossi, an associate professor providing a reference, to comment on how long they've known Fanane, in what capacity, ratings in various areas, an evaluation of Fanane's success potential, and an overall recommendation.

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Yassket
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32 views

Reference - Form 1 TR

The document is a reference form for a graduate program applicant named Yassine Fanane. It contains sections for the applicant's contact information, proposed area of study, and a waiver statement. The rest is to be completed by Thomas Rossi, an associate professor providing a reference, to comment on how long they've known Fanane, in what capacity, ratings in various areas, an evaluation of Fanane's success potential, and an overall recommendation.

Uploaded by

Yassket
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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The Graduate School www.salemstate.

edu/graduate
352 Lafayette Street, Salem, MA 01970-5353 978.542.6323 email: [email protected]

Reference for Graduate Admission


This section to be completed by applicant. Please print and remember to check your proposed area of study.

FANANE YASSINE
Full Name: _____________________________________________________________________________________________________________
Last Name First Name Middle Initial

48 JONES RD, APT 2 REVERE MA 02151


Local Address: _________________________________________________________________________________________________________
No./Street City/Town State/Province Postal Code

Proposed Area of Study: Check ONE


  Master of Arts     English     History
  Master of Arts in Teaching
     Art        Biology          Chemistry     English as a Second Language   PK-9   5-12
     English         History         Mathematics
     Middle School General Science     Spanish   Initial P-6        Initial 5-12
     Middle School Mathematics        Professional P-6        Professional 5-12
  MA/MAT English   
  Master of Business Administration 
  Master of Education
*    Higher Education - Student Affairs
     Bilingual Education                            Library Media Studies (all levels)
     Early Childhood Education    Initial PK-2    Professional PK-2     Physical Education (must have initial licensure)    PK-8     5-12 
     Educational Leadership      PK-6           5-9          9-12         Professional Studies in Technology Education (all levels)
     Elementary Education       Initial 1-6       Professional 1-6         Reading (all levels)
     Middle School            Initial       Professional           School Business Officer
     Secondary Education               School Counseling    PK-8    5-12 
     Special Education:     Initial PK-8    Initial 5-12    Professional PK-8    Professional 5-12
  Master of Science
     Counseling & Psychological Services    Criminal Justice    Geo/Information Science    Industrial/Organizational Psychology
     Mathematics    Nursing    Nursing/Master of Business Administration    Direct Entry/MSN    BS/MS Occupational Therapy
  Certificate Programs
     CAGS in Educational Leadership (in cooperation with the Northeast Consortium for Staff Development)   Business
     English as a Second Language (ESL)         Financial Planning        Geo-Information Science       Nursing Education
     School Counseling     School Adjustment Counseling     Advanced Professional Studies in Counseling
  Fast Track Programs
     Science      Mathematics
  Licensure Only Programs       Reading: Initial
      Early Childhood: Initial                Elementary: Initial            Middle School: Humanities Initial     Secondary
      Early Childhood: Professional           Elementary: Professional        Middle School: Math/Science Initial 
      Special Education:    Initial PK-8    Initial 5-12    Professional PK-8    Professional 5-12         

Thomas Rossi
Name of Individual Providing Reference: _________________________________________________________________________________

Associate Professor
Position/Title: __________________________________________________________________________________________________________
Disclosure Provisions
The recommendation given will become part of your admission file. It will be used only for admission and will not be disclosed to any unauthorized
individual without your written consent. Once the admission decision has been made, all letters of reference will be removed from your folder and
destroyed. Please check the appropriate space below and sign the statement before forwarding this form to your reference for completion.
I have read the information above and hereby: 
Yassine Fanane
*  waive     do not waive  my right of access to this document.

Signature:___________________________________________________________________   August 31, 2010


Date:__________________________________
This section to be completed by the individual providing the reference. Please print.
The applicant named on the previous page has applied for admission to a graduate program at Salem State College.
Under the 1974 Family Educational Rights and Privacy Act, this applicant will have access to your recommendation unless
he/she has waived that right as noted on the previous page.
Once the admission decision has been made, this letter of reference will be removed from the applicant’s file and destroyed.

How long have you known the applicant? ________________________________________________________________________________

In what capacity have you known the applicant? _________________________________________________________________________

Please comment on your general impression of the applicant in terms of the following characteristics:

Superior Above Average Average Fair Unable to Evaluate


Scholarship
Professional Attitude
Leadership Potential

RATING Judgment
Self-confidence
Written/Oral Communication
Skills
Attention to Detail

Below please briefly state your opinion of the applicant’s probability of success as a graduate student and as a professional
pursuing a career in his or her field. Comments relating to an applicant’s strengths and weaknesses are most helpful.
Please feel free to attach an additional page if you require further space for your comments.
Thank you for taking the time to complete this reference.

STATEMENT

OVERALL RECOMMENDATION:
     YES, I HIGHLY RECOMMEND FOR ADMISSION.   YES, I RECOMMEND FOR ADMISSION
     YES, WITH RESERVATIONS.     NO, I DO NOT RECOMMEND FOR ADMISSION

Please mail directly to: Salem State College, The Graduate School, 352 Lafayette Street, Salem, MA 01970-5353

Name of person writing reference: _______________________________________  Position: _____________________________________

Institution: _____________________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________

Signature: ______________________________________________________________  Date: ________________________________________


SGS_224/2009

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