APNO SCHOLARSHIP LETTER OF REFERENCE
APPLICANT: Wavier to access
I, _______________________, waive ___do not waive ___ my right to inspect and review this form upon its completion.
___________________________________ ___________
Signature of applicant Date
EVALUATOR: The person identified above is student at _____________________ in a graduate level program which will prepare him or her for an advance practice nursing role. He or she has applied for a scholarship from the Advance Practice Nurses of the Ozarks. Please evaluate the applicant on the criteria below and return this form directly to APNO. Your prompt attention to this request will be appreciated as the application cannot be further evaluated without your comments.
EVALUATION:
1. How long have you known the applicant?
2. What is your relationship to the applicant?
Instructor Supervisor Employer Colleague Other
3. Please provide a few brief comments indicating your evaluation of the
applicant’s personal strengths, accomplishments, or other considerations
that would indicate why this applicant should be considered for a
scholarship. May attach comments.
____________________________________ __________
Signature of Evaluator Date
____________________________________ __________
Printed Name Title if applicable
RETURN FORM TO: Advance Practice Nurses of the Ozarks
ATTN: Scholarship Committee
PO Box 3216
Springfield, MO 65808
