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KP Nurse Scholars Academy | Kaiser Permanente Northern California Kaiser Permanente Nurse Scholars Academy

Mental Health Scholars Academy Letter of Recommendation Form

  • Applicant

    Information about the Mental Health Scholars Academy applicant.
  • Applicant Name:

    Degree Program:

    Mental Health Scholars Academy program website:

  • Evaluation

    The person named above has made application for graduate study and tuition support through the Mental Health Scholars Academy (MHSA). We would greatly appreciate your candid appraisal of the applicant.
  • Note: Please be as specific as possible (e.g. professor, manager, supervisor, mentor, etc.).
  • Please provide a rating (Outstanding, Superior, Good, Fair, Poor, Unable to judge) based on your perception of the candidate for the following characteristics:
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • (e.g. writing, aptitude, timeliness, critical thinking, etc.)
    OutstandingSuperiorGoodFairPoorUnable to judge
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • OutstandingSuperiorGoodFairPoorUnable to judge
  • Recommender

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  • I hereby certify that the information I am submitting is complete and accurate. I understand that checking "I Agree" above acts as my signature on this form.
  • MM slash DD slash YYYY
    Enter today's date.
  • This field is for validation purposes and should be left unchanged.

Questions? Contact us.

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