EmailMe Form - Administrator/Supervisor Recommendation Form

Name of Applicant *

First Last

Has Applicant Worked For You For At Least One Year? *

Yes

No

*If no, you must verify prior employment to ensure one year long-term care work experience. Please list prior employer and length of employment below

Previous Employer

Previous Employment Dates (MM/DD/YY)

Your Name *

Your Title *

Your Place of Employment *

Your Business Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Business Phone *

### - ### - ####

Your Email *

What is your relationship to the applicant? (Examples: Housing manager, department head, supervisor) *

Please describe why you believe this applicant would be a worthy recipient of the Care Providers of Minnesota Foundation scholarship. Please provide a specific example. *

Please provide a specific example where the applicant made a positive impact because of care or services provided: *

NOTE: Specific Example REQUIRED

Provide us with some insight as to the character of the applicant. Please include some reflections on the criteria listed below:

Recognition and response to customer needs *

Commitment to residents and clients *

Ability to communicate effectively *

Teamwork *

Customer service skills *