LSUS/LSUHSC-Shreveport MPH Applicant Recommendation
Evaluator:
The LSUS/LSUHSC-Shreveport MPH Program would like to thank you for taking time to complete your recommendation on this applicant.
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1.
Please type the name of the applicant your are referring for the MPH Program:
(Required.)
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2.
Type your First Name
(Required.)
3.
Type your Last Name
4.
Your Occupation:
5.
Your Organization:
6.
Your email:
7.
How long have you known the applicant?
8.
How Well do you know the applicant?
Extremely Well
Moderately
Not Very well
9.
In what capacity do you know the applicant?
10.
Please rate the following characteristics for this applicant:
Not Observed
Below Average
Average
Above Average
Excellent
Adaptability
Not Observed
Below Average
Average
Above Average
Excellent
Empathy
Not Observed
Below Average
Average
Above Average
Excellent
Ethics
Not Observed
Below Average
Average
Above Average
Excellent
Intellectual Ability
Not Observed
Below Average
Average
Above Average
Excellent
Interpersonal Relationships
Not Observed
Below Average
Average
Above Average
Excellent
Judgement
Not Observed
Below Average
Average
Above Average
Excellent
Leadership
Not Observed
Below Average
Average
Above Average
Excellent
Oral Communication - English
Not Observed
Below Average
Average
Above Average
Excellent
Professional Appearance
Not Observed
Below Average
Average
Above Average
Excellent
Reliability
Not Observed
Below Average
Average
Above Average
Excellent
Written communication - English
Not Observed
Below Average
Average
Above Average
Excellent
11.
What is your recommendation concerning the applicants admission to the program?
Highly Recommend
Recommend
Recommend with Reservations
Do Not Recommend
12.
Please use the space provided to supply any additional information on the applicant: