University of Wisconsin–Madison Division of Continuing Studies

St. Mary's Minority Health Care Scholarship Program, Recommendation Form

Applicant's Name

The above named individual has applied for a scholarship with St. Mary's Hospital Medical Center. As part of the selection process, three written recommendations are required.

Please evaluate this person with statements relative to qualities such as character, initiative, scholastic performance, responsibility, work habits, and professional interests, including a statement regarding your relationship to this individual.

Please return the completed recommendation form to the Personnel Department in an envelope by (         )

Signature and Date

Send to:

St. Mary's Hospital Medical Center
Personnel Department, 707 S. Mills Street
Madison, WI 53715
608-259-5566, 800-236-6101

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www.dcs.wisc.edu • Updated August 21, 2006