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Faculty Reference/Evaluation Form
Based on your experience with the student in the classroom or clinical setting, please evaluate the student on the following items using the appropriate descriptor.
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Student Name
*
Your answer
Work Skills
*
Very Good
Good
Average
Below Average
Organizational skills
Technical skills
Communication skills
Very Good
Good
Average
Below Average
Organizational skills
Technical skills
Communication skills
Attitude Towards Work
*
Very Good
Good
Average
Below Average
Attitude toward learning new skills
Ability to adjust to new situations
Ability to work with others
Ability to work independently
Very Good
Good
Average
Below Average
Attitude toward learning new skills
Ability to adjust to new situations
Ability to work with others
Ability to work independently
Personal Qualities
*
Very Good
Good
Average
Below Average
Integrity
Attendance
Appearance
Capacity for future leadership
Very Good
Good
Average
Below Average
Integrity
Attendance
Appearance
Capacity for future leadership
What are the applicant’s strengths?
*
Your answer
What areas need further improvement?
*
Your answer
What is your overall evaluation of this student compared to others at the same level in your program?
*
Your answer
Additional comments/concerns:
*
Your answer
Faculty Name & Title:
*
Your answer
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