Skip to main content
Update your Medicaid information today! Georgia is checking who is still eligible to receive Medicaid and/or PeachCare for Kids® coverage. Visit
staycovered.ga.gov
to update your contact information NOW!
Search
Support for Young Adults
Support for Family Members
Support for Professionals
Resources
close
Search for:
search
Care & Treatment
Locations
Find a Doctor
Patient & Visitor Info
About Us
Make an Appointment
menu
Search
close
Search for:
search
Care & Treatment
Locations
Find a Doctor
Patient & Visitor Info
About Us
Make an Appointment
Support for Young Adults
Support for Family Members
Support for Professionals
Resources
Reach for the Stars - Manager/Supervisor Recommendation
Name of Applicant:
(Required)
Approximately how long have you known the applicant?
(Required)
How well do you know the applicant?
(Required)
Casually
Well
Very Well
In what capacity do you know the applicant?
(Required)
Current Manager
Supervisor
Upon the applicant’s completion of their Nursing degree, would you hire the applicant to work under your supervision?
(Required)
Yes
No
Applicant’s Intellectual Ability:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Language Ability:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Ability to Express Ideas Orally:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Emotional Maturity:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Motivation to Achieve:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Interpersonal Skills:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
Applicant’s Leadership Aptitude:
(Required)
Exceptional
Above Average
Average
Below Average
No Information
In summary, the weight of my overall recommendation would be:
(Required)
Very Strong
Strong
Average
Recommendation with Reservations
No Recommendation
Please express your view about this individual’s intellectual ability, emotional maturity, motivation to achieve and excel in the Reach for the Stars Nursing Scholarship Program and to succeed as a future nurse at Grady Health System.
(Required)
Name of Respondent:
(Required)
First
Last
Title:
(Required)
Phone:
(Required)
Organization:
(Required)
Address:
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code