RECOMMENDATION FORM
Data Privacy Clause: By completing this form, I hereby agree that Miriam College may collect, use, disclose, and process my personal data for the
purpose/s of application for admission, scholarship, or enrollment. Requests for inspection, amendment, or restriction of records must be in writing and
addressed to the HEU Admissions Office and must specify the reasons for the request. Miriam College reserves the right to respond appropriately
according to law.
For: Incoming First Year (Senior High School Graduates)
Transferee (applicants who have earned units from another college / university
Note: Incoming First Year applicants need to submit two (2) recommendation forms from their Class Adviser and their Guidance Counselor.
Transferees need to submit two (2) recommendation forms from their professor or program chairperson and Guidance Counselor of the college
they attended.
Name of Applicant: ________________________________________________________________________________
(As appears in birth certificate) LAST NAME FIRST NAME MIDDLE NAME
Present Address: _________________________________________________________________________________
School: _______________________________________________ TEL. NO.: _____________________________
School Address: ______________________________________________________________________________
TO THE PERSON RECOMMENDING:
This form is a confidential report written on behalf of the applicant named above and will be used solely for the
purpose of admission. We would benefit from your perspective in providing us with impressions of the applicant’s personal
qualities and contributions to your school or organization. Please remember that your valuable recommendation would help
facilitate appropriate placement of your student in our institution. Please return this form in a sealed envelope with your
signature on the flap.
BASES OF RECOMMENDATION
This report is based on: Relationship to the applicant:
Personal contact with the applicant Teacher / Professor
Teacher’s comments Guidance Counselor
Guidance records / test results Research Adviser
Observations of other counselors / teachers Supervisor
Others: ____________________________ Employer
How long have you known the applicant? ___________________
How often do you meet with the applicant? ___________________
How well do you know the applicant? ___________________
GENERAL EVALUATION
1. How would you rate the applicant in terms of the following characteristics? Please check the most appropriate box.
Excellent Above Below No Basis for
Personal Traits (Top 10%) Average
Average
Average
Poor
Judgement
Ability to work with others
Academic self-discipline
Analytical / Logical ability
Communication skills Oral
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Written
Concern for others
Excellent Above Below No Basis for
Personal Traits (Top 10%) Average
Average
Average
Poor
Judgement
Creativity
Critical thinking
Emotional stability
Energy and enthusiasm
Independence / Decision-making ability
Initiative / Motivation
Integrity / Honesty
Intellectual ability and capacity
Intellectual curiosity and interest in learning
Leadership ability / Influence
Maturity
Respect accorded by peers
Responsibility
Self-confidence / Ability to deliver
Sense of humor
2. Please answer the following questions briefly.
a. Based on your observations, what are the applicant’s skills and potentials?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
b. Did the applicant manifest any behavioral difficulties or challenges? If yes, how did the applicant manage it?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
c. Are there any accomplishments or personal circumstances that we should know about the applicant?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
3. For Guidance Counselors:
Please identify the factors that might interfere with the applicant’s academics / personal relationships at Miriam College.
Family Relationships Financial Concerns
Peer Pressure Behavioral
Romantic Relationship Psychological
Identity Issues Learning Difficulty
Health Concerns Others
Please feel free to briefly discuss the applicant’s concern/s: __________________________________________
__________________________________________________________________________________________
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Has the applicant ever been suspended or subjected to any disciplinary action while enrolled in your school?
Yes No
If yes, please state the nature of the offense: ______________________________________________________
__________________________________________________________________________________________
OTHER FEEDBACK
Is there anything you wish to say about the student that is not included here?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
OVERALL RECOMMENDATION
Please state reason(s) if recommended with
Strongly Recommended Recommended with Reservation reservation or not recommended:
Recommended Not Recommended
PERSON RECOMMENDING
Printed Name: For recommending persons
from educational institutions,
Signature: please affix school’s
dry seal here.
Date Accomplished:
Contact No.:
Email Address:
Designation / Position / Subject Taught:
Name of School / Employer:
School / Employer Address:
For INCOMING FIRST YEAR STUDENTS only: For TRANSFEREES only:
Name of Principal: Name of Registrar:
Signature of Principal: Signature of Registrar:
Date Signed: Date Signed:
Kindly enclose this form in a sealed envelope with your signature on the flap. Thank you.
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Rev.0 (2023-08-01)
