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Professional/Supervisor Recommendation Form
Must be completed by a person in an executive position – such as the Nursing Facility Administrator, Assisted Living Director/Manager, Owner/Operator of the company or the applicant’s immediate supervisor.
This form must be be submitted by July 10, 2026.
Applicant Name
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First
Last
Has Applicant Worked For You For At Least One Year?
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Yes
No
Your Name
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Your Employer
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Your Title
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Your Email
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Your Full Business Address
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Business Phone
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What is your relationship to the applicant? (Examples: Housing manager, department head, supervisor)
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Why you believe this applicant would be a worthy recipient of the Care Providers of Minnesota Foundation scholarship. Please provide a specific example.
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Provide us with some insight as to the character of the applicant. Please include some reflections on the criteria listed below:
Please provide a specific example where the applicant made a positive impact because of care or services provided:
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NOTE: Specific Example REQUIRED
Recognition and response to customer needs
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Commitment to residents and clients
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Ability to communicate effectively
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Teamwork
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Customer service skills
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