Summer Research Fellowships
Name of Applicant _______________________ Telephone _________________
Name of Evaluator_________________________ Telephone _________________
Evaluator’s Title or Occupation____________________________________________
Institution, Practice or Place of Business_____________________________________
Evaluator’s Address _____________________________________________________
City______________________ State________________ ZIP Code______________
TO THE APPLICANT: Applicants who are awarded a fellowship have the right, under the family educational rights and privacy act of 1974, to see written evaluations submitted on their behalf, unless they waive that right. Please indicate your choice by signing either statement A or B. Your choice will not be a factor in considering your application.
Applicant’s Signature Date
Applicant’s Signature Date
TO THE EVALUATOR: This candidate has requested that you evaluate him/her for a Summer Fellowship in Neuroscience Stipend and has indicated above whether or not he/she wishes to have access to this evaluation. The information that you provide will only be used for the selection process. A separate recommendation letter should be submitted highlighting the applicants strengths and weaknesses and their promise as a summer research student. Please fill out the form and sign the bottom, seal the form and recommendation letter in an institutional or business envelope, and sign on the back seal. Please release the envelope to the applicant by the application deadline March 11, 2013. Alternatively you may mail the completed reference form to:
1050 N Mills Ave.
Claremont CA 91711
You may also submit your completed recommendation via email to the address indicated below. Please use your institutional email account for your submission.
Questions or concerns should be directed to Tom Borowski, Ph.D. Claremont Colleges’ Neuroscience Coordinator. Email: email@example.com. Phone: 909-607-3808.
Applicant’s Name____________________ Evaluator’s Name_________________
Please indicate your assessment of the candidate in each category below by checking the appropriate space.
Excellent Above Average Average Below Average Unable to Comment
Originality _____ ______ ______ _______ _______
Capacity _____ ______ ______ _______ _______
Industry _____ ______ ______ _______ _______
And reliability _____ ______ ______ _______ _______
Stability _____ ______ ______ _______ _______
Others _____ ______ ______ _______ ________
Skills _____ ______ ______ _______ ________
Verbal Skills _____ ______ ______ _______ ________
Written Skills _____ ______ ______ _______ ________
Instruction _____ _______ ______ _______ ________
Research _____ _______ _______ _______ _________
How long have you known the applicant?________________
In what capacity have you known the applicant? ______________________