TO BE FILLED IN BY APPLICANT:

Name of Applicant: _____________________________________________________________________

Area of Specialization: Clinical _______________ Experimental ________________

APPLICANT: It may be that references will give information more useful to this department and to applicants if their recommendations are confidential. If you think this is the case, you may wish to sign the waiver below. This decision is entirely up to you.

I waive my rights ever to see this form and any supplementary note or letter, if written.

SIGNATURE_____________________________________ DATE________________

RECOMMENDER: If the above form is not signed, this sheet and any supplementary note or letter will be shown to the student any time he/she requests it. This completed form should be mailed directly to the above address. In order for this applicant to be considered for admission, your recommendation must be received.

INSTRUCTIONS: Please complete all FOUR sections. All information is needed for a fair evaluation during the admission process.

I. RELATIONSHIP TO THE APPLICANT:

I have known the applicant for approximately (months, years)____________________________________

Please state your relationship to the applicant_________________________________________________

I know the applicant:

Quite well_______ Fairly well________ Not very well________ Do not know him/her_________

II. COMPARISON OF APPLICANT WITH UNDERGRADUATE STUDENTS I HAVE KNOWN:

                                             
                        Upper     Upper   Upper     Upper       Lower     No Basis for       
                          5%       10%     25%       50%         50%        Judgment                    

Knowledge of          _______  _______   _______   _______     _______      _______        
Psychology                                                                                 

Intellectual skills   _______  _______   _______   _______     _______      _______        
and ability                                                                                

Motivation to work    _______  _______   _______   _______     _______      _______        

Writing ability       _______  _______   _______   _______     _______      _______        

Speaking ability      _______  _______   _______   _______     _______      _______        

Quantitative skills   _______  _______   _______   _______     _______      _______        

Emotional maturity    _______  _______   _______   _______     _______      _______        

Working with others   _______  _______   _______   _______     _______      _______        

Creativity            _______  _______   _______   _______     _______      _______        

Research ability      _______  _______   _______   _______     _______      _______        

M.A. potential        _______  _______   _______   _______     _______      _______        

Ph.D. potential       _______  _______   _______   _______     _______      _______        

ADDITIONAL COMMENTS: Please provide a description of the applicant's skills, strengths and weaknesses. The most important information you can provide about this applicant is information that is not reflected in the applicant's transcript and test scores (i.e., work done outside of class and other characteristics you believe are related to success in graduate school).

IV. RECOMMENDATION:

I feel his/her grades do _______ do not _______ reflect his/her level of ability.

If you have or were to have a graduate program in this student's special area, how would you view his/her application to your program?

Admit with hesitation ________ Admit ________ Reject application ________

Signature _________________________________ Title _________________________ Date __________

Name (please print or type) _______________________________________________________________

Address: ______________________________________________________________________________

Telephone: (______)__________________

Please mail the completed recommendation form and any attachments directly to the following address: Graduate Psychology Admissions Committee; The University of Texas-Pan American; 1201 University Drive; Edinburg, Texas 78539.