ra reference form signed .pdf

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Office of Housing & Residential Programs
NAME OF APPLICANT: Kristina Kolesar

DUE DATE: March 13, 2015

(Please Print)

The above named applicant retains the right of access to this document unless s/he has signed the waiver that follows:
I hereby waive any and all rights of access to this document which is to be included in my application file for the position
of Resident Assistant. This waiver applies to the Family Educational Rights and Privacy Act of 1974, asamended, and
any other similar legislation. I understand that this document may not be used for any purpose other than evaluation of
my qualifications for employment.


March 6, 2015

The above named student has applied for the position of Resident Assistant at Angelo State University and has named you
as a reference. Please complete this form and return it sealed and signed in an envelope (with your signature on the seal of
the envelope) to the above named student or fax it to 325/942-2696. Please comment on the capabilities of this individual
based on your interactions and use examples whenever possible. Thank you for your assistance in our selection process.
Resident Assistant Job Description: The Resident Assistant (RA) assumes an active leadership role in developing and
maintaining a positive community environment within the residence halls. He or she serves as a role model and a
resource person in assisting students in their education and personal growth and development. Successful candidates
demonstrate effective communication skills, leadership potential, an appreciation for differing viewpoints, a willingness to
accept responsibilities and a sincere interest in working with students.
Name of Reference (please print):
Institution or Business:
I know this individual:  Very Well

 Well

How long have you known the applicant?

 Fairly Well

 Casually

 Not Well Enough to Rate

Relationship to Applicant?

Please attach a letter of reference commenting on the following:
1. Please comment on this individual’s self-awareness, flexibility, judgment, ability to express themselves, selfconfidence, and level of maturity.
2. Please comment on how this individual interacts with diverse groups
3. Please comment on this individual’s leadership ability, willingness to assume responsibility, willingness to
confront others, and assertiveness.
4. Please comment on this individual’s administrative ability, time management, organizational skills, reaction
to stress, and promptness in completing assignments/tasks.
5. Please comment on this individual’s strengths and weaknesses.
6. Please offer any additional comments you may have.
 Highly recommend
Reference Signature:

 Recommend

 Recommend with reservations

 Do not recommend

pdh 02/16/13

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