(to be completed by applicant's references)

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Wicks Educational Associates, Inc., -- ETNEP
Reference Form

Name of Applicant:_________________________________

How long have you known the applicant? ________________

Describe your relationship to the applicant (Ex. employer, supervisor, co-worker, etc.): _______________

Please place a check in the box that most accurately describes the applicant.

Please attach an additional page for any relevant information regarding the student's abilities Of special interest is information related to self-motivation, initiative and ability to complete a graduate level program.

Recommendation for acceptance

_____ Strongly Recommend

_____ Recommend

_____ Recommend with qualification(s) (please document)

_____ Do not recommend

Please complete the following:

Name: ____________________________________________

Title: ____________________________________________

Organization: ____________________________________________

Address: ____________________________________________

Telephone: ____________________________________________

Signature: ____________________________________ Date: _____________________

Thank you for taking the time to complete this form. Please return it to:

            Wicks Educational Associates, Inc.
            Maple Building
            Suite 202
            5012 Lenker Street
            Mechanicsburg, PA 17055

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Wicks Educational Associates, Inc., Maple Building, Suite 202, 5012 Lenker Street, Mechanicsburg, PA 17055; Phone: 1.800.807.WICKS or 717.737.2770; Fax: 717.737.7683; E-Mail: wicks@epix.net

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