Login - or - Learn
Contact Us     Maps & Directions     About Us
Find a Provider
Your Medical Home
Find a Facility
Plan Your Visit
Find a Provider
Giving
Mother Frances Hospital
Heart Hospital
Neuroscience Institute
Orthopedics and Sports Medicine

Nurse Extern Peer Reference

NOTE: Reference must be completed by someone who is not a relative of the applicant.

The above applicant is being considered for admission to the Senior Extern Program at Trinity Mother Frances Hospital and Clinics.  We are requesting your help to aid the Admissions Committee in assessing the individual's professional and clinical competencies as a student nurse in order to be granted admission.  Your cooperation in completing this reference will help the committee gain a better understanding of the applicant.



* Indicates required information
First Name of Applicant * 
Last Name of Applicant * 
Middle Initial of Applicant (if known) 
What has been the nature and duration of your relationship with this applicant?  * 
Do you feel that within the boundaries of a student nurse, this nurse has provided care that is safe and effective? * 
Do you feel this applicant has the potential to develop critical decision-making skills? * 
Do you feel this applicant has the potential to develop the leadership skills of a professional registered nurse? * 
Please rate this student regarding their academic performance in his/her graduating class:  * 
Please rate this student regarding their level of leadership in his/her graduating class:  * 
Please rate this student regarding their level of maturity in his/her class as a whole:  * 
Please rate this student regarding their level of integrity in his/her class as a whole:  * 
Please rate this student regarding their level of ability to relate to his/her peers:  * 
Please rate this student regarding their level of ability to relate to those in authority:  * 
Please rate this student regarding their level of ability to accept responsibility:  * 
Please rate this student regarding their level of ability to accept constructive criticism:  * 
Please rate this student regarding their level of ability to be self directed.  * 
Additional comments: (Such as strengths, weaknesses or other information which the information which we should consider in making this decision:  * 
Do you recommend this person for admission? * 
Your Name * 
Relationship to Applicant * 
Address * 
City * 
State * 
Zip Code * 
Phone Number * 
Email Address * 
 
 
Trinity Clinic

Trinity Clinic is the area's preferred multispecialty medical group, with over 350 physicians and mid-level providers representing 40 specialties in 36 clinic locations serving East Texas.

Find a Trinity Clinic ProviderMedical Providers Directory  About Trinity Clinic MyChart

TMFHC app on iTunes

TMFHC app on Android Market