CLINICAL LABORATORY SCIENTIST TRAINEE APPLICANT

To be completed by applicant. Please type. Applicant__________________________________________________________________________________ Address____________________________________________________________________________________ Application Deadline Date_____________________________________________________________________ Name of Program____________________________________________________________________________ Address of Program__________________________________________________________________________ _________________________________________________________________________________________

Evaluator: The remainder of this form is to be completed by the evaluator. The contents of which will be held in strictest confidence from unauthorized individuals. Please type. When completed please mail the original to the program indicated above.
PLEASE DO NOT RETURN TO THE APPLICANT. This evaluation should be received prior to the program deadline date entered above.

A. Familiarity with applicant (how known, how long, and how well known?

B. COMMENTS: Please include in this section all pertinent information you have regarding the applicant, particularly (1) special strengths and weaknesses. (2) any anomalous aspects of applicant's academic record, (3) ability to do independent work, (4) extracurricular activities including employment. This section is invaluable in deciding among applicants where all else appears equal. Please append additional sheets if necessary.