Sea Mar ARNP Residency Reference Form
For more information on this Residency Program, visit our website, http://www.seamar.org/fnpr/.
Applicants Full Name
Reference Full Name
Title and Institution
How do you know the applicant?
How long have you known the applicant?
In what capacity have you worked with this applicant?
Please give examples of this applicant’s commitment or service to underserved populations.
Please give examples of this applicant’s commitment or service to the Latino population.
Please give examples of this applicant’s work ethic, flexibility, and initiative.
For academic letters of recommendation: Please comment on this applicant’s academic skills, including GPA, organizational skills, motivation for self-learning, and feedback from other faculty/preceptors.
For professional letters of recommendation: Please comment on this applicant’s leadership and communication skills, professionalism, organizational skills, and competency.
How would you rate this applicant’s capacity for stress management?
1 - very poor
2 - poor
3 - average
4 - good
5 - excellent
Any additional comments to the last question (put N/a if none).
To the best of your knowledge, please choose the most applicable level of applicant’s Spanish speaking skills:
No Spanish language
Beginner Spanish (only knows limited phrases)
Intermediate Spanish (able to have limited conversations)
Advances Spanish (able to have full conversations)
Fluent Spanish (native Spanish speaker or extensive immersion in Spanish speaking country (2+years))
Any additional comments: