Application Evaluation Form

ODU School of Medical Diagnostic & Translational Sciences
Medical Laboratory Science Program

Three reference forms are required (at least two from an academic source and cannot be provided by the applicant’s relative).
Applicant Name Applicant Name First Last
Major
UIN#
Name/Title of Evaluator
Phone Phone - ### - ### ####
Email
Organization
Waiver Access
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Evaluator: Use the scale below to evaluate this applicant. Please select only one.
Academic Achievements

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Initiative

Initiative Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Dependability

Dependability Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Ability to Express Self

Ability to Express Self Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Integrity

Integrity Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Self Confidence

Self Confidence Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Leadership Abilities

Leadership Abilities Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Cooperation & Attitude

Cooperation & Attitude Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Responsibility

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Comments
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Deadline

The office must receive this evaluation no later than February 1st if the candidate is applying for the traditional program. MLT-to MLS degree completion references are accepted anytime during fall and spring semesters.
Date Date / MM / DD YYYY

Application Evaluation Form

Application Evaluation Form

Three reference forms are required (at least two from an academic source and cannot be provided by the applicant’s relative).

Waiver Access

Evaluator: Use the scale below to evaluate this applicant. Please select only one.

Deadline