Summer Research Fellowships
in
Neuroscience
2013

Recommendation Form

Name of Applicant  _______________________      Telephone _________________

Email: __________________

Name of Evaluator_________________________     Telephone _________________

Evaluator’s Title or Occupation____________________________________________

Institution, Practice or Place of Business_____________________________________

Evaluator’s Email_________________________________

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.

1. I hereby waive my right of access to the applicant evaluation provided by the evaluator named above.

  
___________________                                                        ___________
Applicant’s Signature                                                               Date

1. I do not waive my right of access to the applicant evaluation named above.  He or she should be made aware that I retain my right of access and that the confidentiality of the evaluation is not guaranteed.

  ____________________                                                   ______________
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:

Tom Borowski
Pitzer College
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: thomas_borowski@pitzer.edu.  Phone: 909-607-3808.

Recommendation Form

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

Initiative/
Originality            _____                ______           ______         _______               _______

Intellectual
Capacity               _____                ______            ______        _______               _______

Industry                _____                ______            ______        _______               _______

Dependability
And reliability      _____                ______            ______        _______               _______

Emotional
Stability               _____                 ______            ______        _______               _______

Ability to
Work with
Others                  _____                 ______            ______         _______             ________

Laboratory
Skills                    _____                 ______            ______         _______             ________

Verbal Skills        _____                 ______            ______         _______             ________

Written Skills       _____                ______             ______         _______             ________

Acceptance of
Feedback and
Instruction            _____               _______            ______          _______            ________

Applicant’s
Overall
Potential for
Research              _____               _______            _______         _______            _________

How long have you known the applicant?________________

In what capacity have you known the applicant? ______________________

Evaluator’s Signature_____________________________________

Date_______________