USC Aiken BSN Reference Form

Reference for Admission to the Bachelor of Science in Nursing Program

Name of applicant*

First Name

Last Name

Reference deadline*

Reference Information

Name*

First Name

Last Name

Title

University/college*

How long have you known this student?*

In which course(s) did you work with this student?*

Please rate the applicant's characteristics and skills:*

Please rate the applicant's characteristics and skills:
	Not Observed	Below average	Average	Above Average	Exemplary
Academic ability	Please rate the applicant's characteristics and skills:: Academic ability (Not Observed)	Academic ability (Below average)	Academic ability (Average)	Academic ability (Above Average)	Academic ability (Exemplary)
Work ethic and initiative	Work ethic and initiative (Not Observed)	Work ethic and initiative (Below average)	Work ethic and initiative (Average)	Work ethic and initiative (Above Average)	Work ethic and initiative (Exemplary)
Maturity	Maturity (Not Observed)	Maturity (Below average)	Maturity (Average)	Maturity (Above Average)	Maturity (Exemplary)
Written communication	Written communication (Not Observed)	Written communication (Below average)	Written communication (Average)	Written communication (Above Average)	Written communication (Exemplary)
Verbal communication	Verbal communication (Not Observed)	Verbal communication (Below average)	Verbal communication (Average)	Verbal communication (Above Average)	Verbal communication (Exemplary)
Ability to work in groups	Ability to work in groups (Not Observed)	Ability to work in groups (Below average)	Ability to work in groups (Average)	Ability to work in groups (Above Average)	Ability to work in groups (Exemplary)
Self-motivation	Self-motivation (Not Observed)	Self-motivation (Below average)	Self-motivation (Average)	Self-motivation (Above Average)	Self-motivation (Exemplary)
Acceptance of constructive criticism	Acceptance of constructive criticism (Not Observed)	Acceptance of constructive criticism (Below average)	Acceptance of constructive criticism (Average)	Acceptance of constructive criticism (Above Average)	Acceptance of constructive criticism (Exemplary)

Do you have any reason to doubt this applicant’s academic integrity?*

Yes No

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