ࡱ> tvsa bjbjjj ]?b?b  $|'0F\\\\GGGV'X'X'X'X'X'X'$)+V|'G%"GGG|'\\'G \\V'GV'V>&@'\+ZQ:~& B''0'&x,,','@GGGGGGG|'|'/GGG'GGGG,GGGGGGGGG B X:  INCLUDEPICTURE "http://www2.selu.edu/images/S-onlylogo-sm.jpg" \* MERGEFORMATINET  SOUTHEASTERN PERSONAL REFERENCE FORM LOUISIANA Master of Science in Child Life UNIVERSITY Department of Health and Human Sciences  To the applicant: Please complete the top portion of this form and then deliver it to your references. Applicants Name __________________________________________________________________ The Family Educational Rights and Privacy Act of 1974 and its amendments guarantee students access to their educational records. However, students may waive their right of access to recommendations. Please indicate your choice regarding this recommendation below. Failure to sign will constitute acceptance of limited access. _____ I waive my right to inspect the contents of the following recommendation. _____ I do not waive my right to inspect the contents of the following recommendation. Signature ___________________________________________________ Date _______________________ To the reference/recommendation provider: The person named above is applying for admission to the Master of Science degree program in Child Life at ɫƵ. Please complete this form (2 pages), place it in an envelope, sign your name across the sealed flap, and return it to the applicant as soon as possible. Please feel free to also attach a letter of recommendation that indicates the applicants potential to be successful in a Masters degree program in Child Life. Name ____________________________________________________________________________ Position/Title _____________________________________________________________________ Business Name & Address ___________________________________________________________ _________________________________________________________________________________ Business Phone ( ) __________________ E-mail address: _______________________________ How long and in what capacity have you known the applicant? Briefly state the greatest strengths of the applicant. Briefly state the challenges you believe the applicant will face in a graduate program in Child Life. Please rate the applicant on each of the following items. Only circle Dont Know if you have truly never observed this quality/characteristic/behavior. SkillDon't KnowLowAverageHigh1. Relationship SkillsDK123 456789102. Communication SkillsDK123456789103. Sense of Responsibility/PunctualityDK123456789104. Empathy/Understanding/AcceptanceDK123456789105. Openness/Genuineness/WarmthDK123456789106. Honesty/Integrity/ConfidentialityDK12345678910 7. Cooperation with othersDK123456789108. Ability to Cope/Adjust/Emotional StabilityDK12345678910 9. Maturity LevelDK1234 567891010. Recognition of LimitsDK1234567891011. Crisis/Problem SolvingDK1234567891012. Self-Assessment/Insight/ObjectivityDK1234567891013. Flexibility/AdaptabilityDK12345678 91014.Time Management/EfficiencyDK1234567891015. Sense of Humor/PerspectiveDK1234567891016. Self-Reliance/ConfidenceDK12345678910 17. Intellectual CapacityDK1234 567891018. Goals/Direction/PurposeDK1234567891019. Acceptance of Supervision/FeedbackDK12345678910 20. Energy/Industriousness/Positive AttitudeDK12345678910 Additional comments: Overall recommendation regarding the applicants ability to be successful in a Masters degree program in Child Life: ___ Outstanding ___ Very Good ___ Good ___ Fair ___Poor Signature ____________________________________________ Date ____________________ UW]lV  . 6 C F ɹɝɝɝɹɹ~o~o~^Ohv4hGwOJQJ^JaJ hv4hGwCJOJQJ^JaJhv4h2ECJOJQJ^Jhv4hGwCJOJQJ^Jhv4h2E5OJQJ\^Jhv4h2EOJQJ^Jhv4hGwCJ OJQJ^Jhv4hGw5OJQJ\^Jhv4hGwOJQJ^J!jhv4hGwOJQJU^J0jhv4hGwCJOJQJU^JmHnHu]V W F Cdh]^gd2E^gd2E ]^gd2E ]^]^F ) @ P g h D O <B8=Yoy~޾yk^hv4hv4OJQJ^Jhv4hGw6OJQJ^Jhrjhrj6OJQJ^Jhv4h2EOJQJ^Jhv4hrjOJQJ^Jhv4hGwOJQJ^Jhv4hGw5OJQJ\^Jhv4hGwCJOJQJ^J hv4h2ECJOJQJ^JaJ hv4hGwCJOJQJ^JaJ hv4hGwCJOJQJ^JaJ>{|}~0^0$a$$a$ & F^ & F]gd2E ]^gd2Edh]^gd2E~ !DGHyz*+!"OPjkFGGᮛ{hv4hrjOJQJ^J%hv4h2EB*OJQJ^JaJph%hv4hGwB*OJQJ^JaJph+hv4hGw5B*OJQJ\^JaJphhv4hGw5OJQJ\^Jhv4h2EOJQJ^Jhv4hGwOJQJ^J"hv4hGw5CJOJQJ\^J0 !'26>CDG[R $$Ifa$kd$$If4ֈ0LDT$r'a0f4 $$Ifa$ $$Ifa$ G\_acehjlnpruvy $$Ifa$Ff $$Ifa$ $$Ifa$Ff` $$Ifa$ $$Ifa$ $$Ifa$Ff!#&'*GJLNPRTVXZ\_`cFf $$Ifa$ $$Ifa$Ff) $$Ifa$ Ff $$Ifa$ $$Ifa$Ff $$Ifa$   !1468:<?ACEGJKOFf $$Ifa$ $$Ifa$FfM $$Ifa$Ofikmoqsuwy{~ $$Ifa$Ff $$Ifa$ $$Ifa$!#%Ffq $$Ifa$ $$Ifa$ $$Ifa$Ff%'*-.2MPRTVXZ\^`befjFf& $$Ifa$ $$Ifa$Ff:# $$Ifa$Ff+ $$Ifa$ $$Ifa$Ff( $$Ifa$  ),.02468:<>ABFFf'1 $$Ifa$ $$Ifa$Ff^. $$Ifa$Fjmoqsuwy{} $$Ifa$Ff3 $$Ifa$ $$Ifa$^_ 0]^0gd# 0]^0 0^0`0^0]Ff6GM\%hv4hGwB*OJQJ^JaJph+hv4hGw6B*OJQJ]^JaJphhv4hGw6OJQJ]^Jhv4hrjOJQJ^Jhv4hGwOJQJ^J,1h/ =!"#h$% FREUtf 7JFIFHHPhotoshop 3.08BIM x8BIMxHH(FG(HH(d'@8BIMHH8BIM x8BIM8BIM 8BIM' 8BIM5-8BIM8BIM@@8BIM8BIM Qnh JFIFHHAdobed            nQ"?   3!1AQa"q2B#$Rb34rC%Scs5&DTdE£t6UeuF'Vfv7GWgw5!1AQaq"2B#R3$brCScs4%&5DTdEU6teuFVfv'7GWgw ?TYstl1}uZV.-zunS%%_to 5s~tٲb[>u6vWwSfIo7pЛ?k#c_[SVgtڽ;[F+}=s64~unO7PN=݄?Qq[FwQ}!] -^Pۑm?G sƤ~y;]Ccl֚[>(pINXetNsEŕכYib?X:ćuD˙ߡu_Ժ Γ7dϩq~mAk,v6FWW3k?Y};v-ŷ94K2e3~iVM3fb򿟧 q%)$IOG9i{kZ%:r[z5te}{mݏFoЖcϧ dct*YwZc73=/^镰~[]ecd:=vlosSgA8)9ۍF~5a~nn<0`d~? n7Ԟj+{WIMbiޚ?^J{(`6c2vs=O#[}JȬW<:=t$SKqprf[XFlϯs=:n2Snnh{,/^4;#3>3W-Ϫtgc[BN]A zm IO#^÷elG3N=.SMfE;WkN򪱮jwLF[Ԛ=w_ok]IaHp'"eݏn$I$Srs+Kݮ?վ#_fmVaZϫulrEVHYgqdu_/9/V|}\n@ح*Ʃ㱻$?[KվӘ&۪&c?MH+j\΅8%#[KկלbަzBhn{~F,OYWdз1%=տ3'NnvC}oPZn:վn}yDҪe2gYpTO?]S$I)ze}[t8ʥՂ{8ѿmzl7Ki_=_ kLK6klWm5ձ%>!%+)IOYzv$}l}y\6}R1:@Ek]ܶt"j~;JtRI$[~^߳EYG _Xu9^}E~*5>57~}">pϨ]p߃5Ǥ;+XmunӚs=V*^Dz5psCWο]>_; 6cZ=\K.Zשqtue(&:$}i.ae?rI)r}G]?N m_fȩYeW_4b}Ŗuvn%Nps YYX6es=F؟ZnGm[bJw>}q.>Ee 7a n߽ſMMwTwWkCݮW!6pF_]mw{йUZ}"݌k4~i)I1 I5$Džl8]*#mU?>՜?6,uzp^-6_k,?2qwػ%^8Cۏ[?K]IOI}'fu+>-/~۳k~c>tf_Zzmww}?sPS0M7#{>He4u7d>:~#G5n$tSG5iks\ #>E1ݓw%ږ/~./ jVw\k 9[[5e6w7Jy.ԭ};/]:4{ց?]^Sr:kʎǻx?Go˯̚z_[쯭xzީP^Hn{w{.?מ~n};KOk::`[*cf ?Q~V t0Hw/NV,Σ!,n2w'F2iR֏d$)E63;2U-ѭ7b~gӎVQs常kw#'SX&kwFE-UG¬ٙ}`g_:tΏGw2~~CCG󟥷)nպ.-K, }fqf5G N%cߡ:7KK!6Ze;˶9C4[ֺXha=SX=q%)$IOTI%5:I[ [}Sl걿Z¿gu8MvuNGU]]BI)\*OT:uߜh?ȳm?^:d)=zzI)00^[N.pf5eɺշ~t]B?;UZ$$I)I$J8BIMICC_PROFILEADBEmntrGRAYXYZ   ,acspMSFTnone-ADBEcprt$descqwtptXbkptlkTRCtext(c) 2001 Adobe Systems Inc.descGrayscale - Gamma 2.2XYZ QXYZ curv3AdobedC        nQ  s!1AQa"q2B#R3b$r%C4Scs5D'6Tdt& EFVU(eufv7GWgw8HXhx)9IYiy*:JZjz?Z״/Y{W[xI 5gَK#~F->}q{8򆌟uEIY?m9 {Q12;y,v_0S"M;͚7ȷzoG ,_c%uǛ`W׭nӈY^WZEw1 M I͟Mo2YgOs\oC71oZ|Y5N0y͉szq٫+\7-VO]u5}Xd֏z6/SPyCzrٳZs͈O=-=Hc8Uy^Y-GH#p-j?2jQy;>vmvI˷n߹OO^c+4 bPA{o^"ֽ>/x2d640T@YrIS?⵿S;/'Y6őF ݷ'uYǂv+% Mx(gjёg7?FHyzW'MuH%t7Oi_Nk~nӮ4k^Li;PzNp]n?c:53hźŻ}gˆ/-퍏$1ld4eA6Fi"wV6uʹ^FhW`04"?Lx}y5ưa òK2$Is=-޿0i39wyVS4Wlr R+)-eWZGzkR*3F򮳢fC̶: cƭOڌ _xxymyه6[ ^B؏3۵2qӟ^_|;;G ?sWՠ?_:h?owWDI=2Q _Frݍ"&5\ח5)z՘ua/&꼆,/BѶ{#rѼIҋsj`?H3fŸ3yږ0oI" qVo=_p][OI1guߟ1%_:?e <V\PM3ʺ- ,#g]q'&yaPpjH\_/d|Hּdi˧j6 'KKusnGzsf'Qia_s %?h!ow*̿!>w[ }F׏ˈ//ܽ}SUE*=AN(֏[w{GWe-o⩂Zn r~mEΏ_w+Ӟrz;}a/ȿOXXx#c?w/3.XΉ XMx?)$_Fkme5F{X[,IODמuk?9h z}b5kyoJi.yyzk 9tYxsk}eiwua5輑eEVPf⟳y⺷ FáW͜'rZF~,Upqe\W[Z^?,dbksI?꿻OrqL~^ҦAЦƭs3Gݟ1gae8[.\" 80>v dF[_%f[kPʿ=œoT&?a羘5۹O =?$̀?"y0ht_ܿec@7$_-N˼=;ѳ<-Kig9&ʖ?ʒj|J??EAyoӾut?-Q'a )7`쿼|yo{?*\L#go^Kei_ M/ڞO%9Zд0 b.`$2dqdE"c:E3v@P~Ds |w< >F ~G G O%F UVCl,R$EUtf 7Z.>@L(    C tA\ http://www2.selu.edu/images/S-onlylogo-sm.jpg"?B S  ?LTJNTXcn3333-.6COP]`abgghsO<B8=oy~~G H y z * + ! 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