Medical Lab Scientist Scholarship Recommendation Form

Please rate the applicant on the criteria listed below and provide any additional information that may assist the scholarship
selection committee.

All recommendations are confidential.

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* 1. MLS Scholarship Applicant's Name:

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* 2. What is your relationship with the applicant?

Head of MLS/CLS program

Manager/Supervisor

Professor

Other (please specify)

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* 3. Length of time you have known the applicant?

Less than 1 year

1-2 years

2-5 years

Greater than 5 years

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* 4. Please rate the applicant on the following:

	Below average	Average	Above Average	Outstanding
Demonstrates passion in caring for patients or a passion for providing service to customers	Demonstrates passion in caring for patients or a passion for providing service to customers Below average	Demonstrates passion in caring for patients or a passion for providing service to customers Average	Demonstrates passion in caring for patients or a passion for providing service to customers Above Average	Demonstrates passion in caring for patients or a passion for providing service to customers Outstanding
Demonstrates initiative	Demonstrates initiative Below average	Demonstrates initiative Average	Demonstrates initiative Above Average	Demonstrates initiative Outstanding
Achievement oriented	Achievement oriented Below average	Achievement oriented Average	Achievement oriented Above Average	Achievement oriented Outstanding
Actively seeks out learning, ongoing development	Actively seeks out learning, ongoing development Below average	Actively seeks out learning, ongoing development Average	Actively seeks out learning, ongoing development Above Average	Actively seeks out learning, ongoing development Outstanding
Dependability	Dependability Below average	Dependability Average	Dependability Above Average	Dependability Outstanding
Quality of work	Quality of work Below average	Quality of work Average	Quality of work Above Average	Quality of work Outstanding
Ability to get along with and respect others	Ability to get along with and respect others Below average	Ability to get along with and respect others Average	Ability to get along with and respect others Above Average	Ability to get along with and respect others Outstanding
Accepts responsibility	Accepts responsibility Below average	Accepts responsibility Average	Accepts responsibility Above Average	Accepts responsibility Outstanding

Comments

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* 5. Are you aware of any applicable academic discipline the applicant is involved in?

Yes

If yes, please explain

Medical Lab Scientist Scholarship Recommendation Form

Question Title

* 1. MLS Scholarship Applicant's Name:

Question Title

* 2. What is your relationship with the applicant?

Question Title

* 3. Length of time you have known the applicant?

Question Title

* 4. Please rate the applicant on the following:

Question Title

* 5. Are you aware of any applicable academic discipline the applicant is involved in?

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* 6. Any additional comments?

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* 7. This recommendation was completed by?

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* 8. Phone number:

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* 9. E-mail: