HEALTH PROFESSIONS ADVISORY COMMITTEE STUDENT EVALUATION FORM
To the student:
Fill in the information requested on this page and on page 4 and 5 of this form. Of the types of schools listed below, please indicate your choice. If you select more than one, indicate the order of preference, i.e., first choice is number 1.
To Professor: _______________________________ Date: ________________
_________________________________________________ is planning to apply for
admissions to the following type(s) of school(s):
|
Dental |
Medical |
Optometry |
Osteopathy |
Podiatry |
Veterinary |
The Health Professions Advisory Committee of Lycoming College would appreciate receiving your evaluation of the applicant. This will be used to write one letter of recommendation to the professional schools to which the applicant applies.
The health professions schools are interested in the applicant's character, personality, intellectual capacity, etc. We are asking you to consider the various aspects of the applicant's work - papers, experiments, projects, performance in class, etc. - which might reflect on aptitude for health profession training.
In order to help the Committee write its formal letter of recommendation, we ask that you check the attached rating sheet and use page 3 for comments on the student's traits, abilities, etc.
TEAR OFF AND RETAIN THE LAST PAGE OF THIS FORM FOR YOUR RECORDS.
Do not return this evaluation form to the
applicant; return it to: Dr. Edward G. Gabriel, Department of Biology,
Lycoming College, Williamsport, PA 17701.
HEALTH PROFESSIONS ADVISORY COMMITTEE
| ___________Confidential | Evaluation of: ____________________________ |
| __________ Non-confidential | Name of Course: __________________________ |
| Date: __________________ | Course Number: __________________________ |
| General Impression |
1 Superior |
2 |
3 Average |
4 |
5 Unsatisfactory |
6 Not Rated |
| Ability to communicate | ||||||
| Academic Achievement | ||||||
| Concern for others | ||||||
| Cooperation | ||||||
| Dependability | ||||||
| Emotional Stability | ||||||
| Industriousness | ||||||
| Integrity | ||||||
| Manual Dexterity | ||||||
| Maturity | ||||||
| Motivation | ||||||
| Originality | ||||||
| Personal Appearance | ||||||
| Personality | ||||||
| Self Confidence |
HEALTH PROFESSIONS ADVISORY COMMITTEE
_____ Confidential Evaluation of: _________________________________________
_____ Non-confidential
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Did the grade reflect his/her intellectual potential? _______________________________
In what capacity and how well did you know this
student? __________________________
Do you wish to reassess your evaluation before the Committee reviews this candidate's file
at the end of his/her junior year? _________________________________________
Recommend enthusiastically: ______________ Recommend with reservation: ________
Recommend with confidence: _______________ Not Recommend: _____________
Recommend: _______________
Faculty member: ___________________________________
Title and Department: _____________________________
Please return this form to Dr. Edward G. Gabriel, Department of Biology, Lycoming College, Williamsport, PA 17701.
TO BE COMPLETED BY STUDENT
I understand that, according to Section 438 of the General Education Provision Act (commonly known as the Family Education Rights and Privacy Act of 1974, as amended), students have the right to access certain of their personal education records such as those maintained by the Health Professions Advisory Committee. However, students may waive the right to access to confidential recommendations maintained for the purpose of admission to graduate schools.
____________ I wish to waive the right of access
to my folder in the file of the Health Professions Advisory Committee and
thus wish to have the attached form considered as a confidential letter
of recommendation.
____________ I do not wish to waive the right of access to my record and wish the attached form to be considered as a non-confidential letter of recommendation.
Signed: ________________________________
Date: __________________________________
Professor: Keep this for your records.
TO BE COMPLETED BY STUDENT
I understand that, according to Section 438 of the General Education Provision Act (commonly known as the Family Education Rights and Privacy Act of 1974, as amended), students have the right to access certain of their personal education records such as those maintained by the Health Professions Advisory Committee. However, students may waive the right to access to confidential recommendations maintained for the purpose of admission to graduate schools.
____________ I wish to waive the right of access
to my folder in the file of the Health Professions Advisory Committee and
thus wish to have the attached form considered as a confidential letter
of recommendation.
____________ I do not wish to waive the right of access
to my record and wish the attached form to be considered as a non-confidential
letter of recommendation.
Signed: ________________________________
Date: __________________________________