Application Evaluation Form

ODU School of Medical Diagnostic & Translational Sciences
Cytology 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
The applicant reserves the right to view the reference. I have chosen to have this evaluation remain:

The applicant reserves the right to view the reference. I have chosen to have this evaluation remain: Confidential (Candidate will not have access to confidential evaluations) Not Confidential
Date Date / MM / DD YYYY
Evaluator use the scale below as a guided to evaluate this applicant in the areas indicated.
Academic Achievements

Academic Achievements Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
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

Responsibility Unable to Evaluate Excellent Above Average Average Below Average Unsatisfactory
Comments
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Deadline

This evaluation must be received by this office no later than April 30th.
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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 as a guided to evaluate this applicant in the areas indicated.

Deadline