The National Academies: Advisers to the Nation on Science, Engineering, and Medicine
Christine Mirzayan Science and Technology Graduate Fellowship Program
NATIONAL ACADEMY OF SCIENCES NATIONAL ACADEMY OF ENGINEERING INSTITUTE OF MEDICINE NATIONAL RESEARCH COUNCIL


Reference * Required information
A standard reference is unlikely to be sufficient.

Candidate Information:

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Last Name:*

Reference Writer's Information:

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Last Name:*
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1. What is your relationship to the candidate?


2. Please provide the following assessments of the potential candidate's characteristics:

Relations with Others
Exceptionally well accepted
Works well with others
Gets along satisfactorily
Has some difficulty working with others
Works very poorly with others
N/A

Judgment
Exceptionally mature
Above average in making decisions
Usually makes the right decision
Often uses poor judgment
Consistently uses bad judgment
N/A

Ability to Learn
Learns very quickly
Learns readily
Average in learning
Rather slow to learn
Very slow to learn
N/A

Non-technical Writing Ability
Excellent writer
Good writer
Average writer
Poor writer
Unable to communicate
N/A		Attitude - Application to work
Outstanding in enthusiasm
Very interested and industrious
Average in diligence and interest
Somewhat indifferent
Definitely not interested
N/A

Dependability
Completely dependable
Above average in dependability
Usually dependable
Sometimes neglectful or careless
Unreliable
N/A

Quality of Work
Excellent
Very good
Average
Below average
Very poor
N/A

Overall Evaluation Relative to Peers:
Outstanding (top5%)
Very Good (top 25%)
Average (top 50%)
Marginal (less than 50%)
Poor (less than 5%)
N/A

3. What are the candidate's strongest assets?

4. What qualities and characteristics should the candidate especially strive to improve?

5. Do you have other comments that you feel would be helpful to the National Academies in the screening of this candidate?


Thank you for taking the time to fill out this reference form on behalf of the candidate.

NOTE: To retain a file copy of the reference, please print a copy before submitting the completed form.



 

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