Letter of Recommendation Student Name: Date: Note to the

Idaho State University

College of Technology

Occupational Therapy Assistant Program

Letter of Recommendation

Student Name: ___________________________ Date: ____________________

Note to the Applicant:

Complete the top section with your printed name before forwarding it to your recommender.

Provide your recommender with a self-addressed stamped envelope to: Idaho State University,

OTA program, 921 South 8

Avenue, Stop 8380, Pocatello, Idaho 83209. Or they may fax it to

208-282-5195 or email it to ctechss@isu.edu.

I hereby waive my right to access to this letter of recommendation to encourage the reference

to provide a candid assessment. As well, this letter will remain confidential. I understand that a

letter of recommendation from a family member is unacceptable.

__________________________ ___________________________

Signature of Applicant Date

Recommender Name Place of Employment

____________________________(please print) ____________________________________

__________________________ _____________________________

Recommender’s Signature Date

Note to Recommender:

Thank you for assisting the above-named person in applying to the Idaho State University

Occupational Therapy Assistant Program. Applicants to the ISU OTA program are required to

select TWO references to complete this form. The form is intended to provide insight into the

personal and professional behaviors of the applicant. The ISU OTA admission committee

requests that you complete this form with all honesty to ensure that the most appropriate

students are selected for our program. Upon completion of the evaluation, please place the

form in the attached self-addressed stamped envelope with your signature across the seal and

return it to the student.

1. I have known the applicant for ____months or ____ years.

2. Relationship to applicant: ____________________________

3. I feel that I know the applicant: ___ very well ___ well ____ not very well

4. Please rate the applicant by checking the number that best reflects your judgment of

the applicant:

Idaho State University

College of Technology

Occupational Therapy Assistant Program

Excellent Good Fair Poor

Attributes:

4 3 2 1

N/A

Writes and speaks with organization and clarity

Relates effectively to persons in authority

Responds maturely verbally and non-verbally to

others

Constructively works with others

Follows directions well and asks for clarifications

when needed

Demonstrates self-confidence

Utilizes effective processes to solve problems

Accepts responsibility for his/her behavior and is

ethical

Is flexible/adaptable

Works independently

Demonstrates initiative

Grasps new concepts quickly

Dresses appropriate to the situation

Demonstrates safety awareness

Please provide any comments if you wish to do so:

________________________________________________________________________

The Idaho State University OTA selection committee thanks you for your willingness to

assist in this selection process.