Reference Form for Student Applicant

Dear Reference:

Thank you for taking the time to serve as a reference.  Our students need to possess the qualities and maturity needed to interact in a small group with other students and provide professional services to clients.  When a student completes our program, they will be eligible to apply for a bodyworker's license. We are committed to providing a quality education, which is rooted in strong professional ethics.  Since we are committed to training exceptional health care professionals, we appreciate any information you can provide. 


Please Rate the Following:

Communications SkillsPoorFairGoodVery goodExcellent Communications Skills
Problem SolvingPoorFairGoodVery goodExcellent Problem Solving
Learning AbilitiesPoorFairGoodVery goodExcellent Learning Abilities
Professional EthicsPoorFairGoodVery goodExcellent Professional Ethics
Feed BackPoorFairGoodVery goodExcellent Feed Back

Electronic Signature Disclosure and Consent Statement You consent and agree that your use of a keypad, mouse, or another device to select an item, button, icon, checkbox, to enter text, or to perform a similar act/action while using the Universal College of Healing Arts website, to access or make any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions, constitutes your signature, acceptance, and agreement as if actually signed by you in writing. You further acknowledge and agree that taking any such actions by you evidence your intent to sign any such agreement, acknowledgment, consent, terms, disclosures, or conditions. You also agree that no certification authority or other third party verification is necessary to the validity of your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract.

Thanks for submitting!