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University Health Services

HealthWorks

RECOMMENDATION FORM

Reference: Please assess the capabilities of the applicant relating to the HealthWorks mission and content areas. Any information you deem important will help us in our interviewing process. Please complete all of the fields on this application.

There are three ways to return this completed recommendation: 1. MAIL to the Office of Health Promotion and Education, room 237 Ritenour Building, University Park, PA 16802, 2. FAX to 814-865-7212 or 3. SUBMIT ELECTRONICALLY. Any questions can be directed to the HealthWorks Advisor at 814-863-0461.

Position Overview: A HealthWorks peer educator assists in educating the community about various health issues through activities such as facilitating workshops, sponsoring University-wide outreach events, and advocating for health related issues within the University community.

General Information

Name of Applicant:

 

Your Name

  

Your Position/Title

How long have you know the applicant?

Relationship to Applicant

  

Please rate the applicant on the qualities listed below

Excellent

Very Good

Good

Fair

Poor

Not Applicable

Ability to work with others

Communication Skills

Time Management

Leadership Potential

Personal Integrity

Ability to motivate others

Role modeling healthy behaviors

Critical Thinking Skills

Commitment to Community

Completion of Tasks

Reliability

Creativity

Please answer the following two questions.

1. What do you consider to be the applicant's strengths?

2. In what areas does the applicant need further development?

3. Any other comments?

I recommend the applicant:

We may find it necessary to follow up on this recommendation.

What is the best way to reach you?

Phone Number (include area code):

E-mail:

Note: If you choose to mail or fax this form, please sign and print your name below:

____________________________
Signature
____________________________
Print Name

Agreement

By submitting this form electronically, I hereby state that I have answered the above questions to the best of my abillity, and agree with all statements made within.

Any questions regarding this program may be directed to the HealthWorks Advisor (Angela Ablorh-Adjidja) in the Office of Health Promotion & Education, 814-863-0461.

Form revised 7/19/00