Pharmacy Technology Reference Request
Date _______________
____________________________________________ is requesting that you provide a letter of reference regarding his/her admission to the Pharmacy Technology Program. After completing this form, please return it to the address shown at the end. Thank you for your valuable contribution.
I have known the applicant for ______ years, ______ months.
The circumstances under which I have known the applicant are:
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On the following chart, please place a check in the box of the rating you believe is representative of this applicant.
Personal Attributes | Exceptional | Above Average | Average | Below Average | No Information |
Intellectual Capacity | |||||
Writing Ability | |||||
Oral Communication Skills | |||||
Problem-Solving Skills | |||||
Intellectual Curiosity | |||||
Motivation to Learn | |||||
Perseverance in Adversity | |||||
Likelihood of Success in the Pharmacy Technology health care field | |||||
Ability to Get Along with Others | |||||
Dependability, Attendance |
Please add any comments that would assist faculty members in the decision of admitting the applicant to the Pharmacy Technology Program. (If more space is needed, attach an additional sheet.)
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Please send form to:
Standards Committee
Pharmacy Technology Program
Lamar State College-Orange
410 Front Street
Orange, Texas 77630
Signature ___________________________________________________________________________
Name (printed or typed) _______________________________________________________________
Position/Title ________________________________________________________________________
Address ____________________________________________________________________________