Online RN-to-BSN Person Serving as Reference Form

This form is to be used by the person serving as a reference for an applicant to the Northwestern Online RN-to-BSN Program. The information provided below will serve as that reference. This reference form will become a part of the student’s permanent file. According to the policy of the Northwestern Oklahoma State University Nursing Program, applicants have access to their personal file upon written request to the Chair of the Division of Nursing unless they waive their right to access. Your cooperation in completing and promptly submitting this form will assist both the applicant and the Nursing Program. Thank you for taking your time to complete this Reference Form. Your contributions are appreciated.

Reference Information

Information regarding applicant being provided for this reference

Rate the applicant on a scale of 5 (highest) to 1 (lowest) on the following attributes. Superior is 5; Poor is 1.


 Check this box as your electronic signature

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