Name of Student  ______________________________   Date _____________ 

Your Name             ______________________________

Position                  ______________________________

Agency                    ______________________________

Telephone Number______________________________

E-mail Address:      _____________________________
 
 

Your candid appraisal of the student named above will assist the Baccalaureate Program in Social Work at the University of Tennessee in its admission process.  One criterion for a student' admission into the junior level social work classes is fifty clock hours of volunteer work in a social services agency/organization.
 

1.  How long (give dates) and in what connection have you known the student?

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

      _______________________________________________________________

2.  Number of clock hours in this volunteer activity  ______________________

3.  Starting date of the volunteer activity  _______________________________
 
 
 

4.  Please rate the student relative to other volunteers whom you have known in a similar capacity.
 

	Below Average	Average	Above Average	Excellent	No Basis For Judgement
Dependability
Oral Communication Skills
Written Communication Skills
Ability to Work With Others
Ability to Problem Solve
Initiative
Cooperation
Level of Maturity
Tactful in Manner and Speech
Sensitive to the Needs of Others
Leadership Potential

Comments:  We would appreciate a statement from you regarding the candidate's volunteer responsibilities in your agency and generally how well the candidate met these responsibilities.
 
 
 
 
 
 

Please provide any additional information and comments which may assist the program in this admission's decision.
 
 
 

Signature  _________________________   Date  _________________