Fillable REQUEST FOR LETTER OF RECOMMENDATION (Northern Illinois University)

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REQUEST FOR LETTER OF RECOMMENDATION (Northern Illinois University)

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1
NORTHERN ILLINOIS UNIVERSITY
SCHOOL OF ALLIED HEALTH & COMMUNICATIVE DISORDERS
PROGRAM IN MEDICAL LABORATORY SCIENCES
REQUEST FOR LETTER OF RECOMMENDATION
INSTRUCTIONS TO THE EVALUATOR:
The below-named person is applying for admission to the MEDICAL Laboratory Sciences Program at Northern
Illinois University. Please evaluate the candidate's performance and potential as it applies to the field of
medical laboratory sciences. Your comments will be used by the program officials to help them better assess
the candidate's qualifications. Your cooperation is appreciated in completing and returning this form directly to
the Medical Laboratory Sciences Program so that it is received no later than the due date for the respective
application period. Please e-mail letter of recommendation to: mlsadmissions@niu.edu
Application period: _______Feb 1_______May 1
Name of Applicant_________________________________________ Student Z-ID #
Address
Telephone # (include area code)
Date Given to Evaluator
Pursuant to federal law a student admitted to our Program in Medical Laboratory Sciences is entitled to inspect
this evaluation in his/her file, unless the student has signed a waiver of this right of access. Students submitting
names of individuals for letters of recommendation are free to determine whether or not they wish to waive their
potential right to examine such evaluations. Please consult the box below to determine if such a waiver has
been granted.
APPLICANT WAIVER
The Family Educational Rights and Privacy Act permits us to request, but not require that you waive your
right to inspect this evaluation. The right, which we request that you waive, would apply if you were an
enrolled student at this school and if the evaluation was maintained after your enrollment. In considering
whether you will waive, please be advised that the information contained on this form will be used to
evaluate you as an applicant for admission to this Program in Medical Laboratory Sciences.
I hereby waive my right to examine the contents of this evaluation.
Signature_______________________________________ Date________________________________
I wish to retain my right to examine the contents of this evaluation.
Signature_______________________________________ Date________________________________
(Type name)
(Type name)
2
EVALUATION OF STUDENT'S
PERFORMANCE AND POTENTIAL
1. How long have you known the applicant and in what capacity?
2. Would you recommend this applicant for a career in medical laboratory science? (CHECK ONE.)
If you would not, or would do so with reservation, please explain your reasoning.
Strongly and without reservation With reservation*
With confidence I do not recommend*
*Comments:
3. Additional comments by evaluator (Include strengths and weaknesses).
(Evaluation continued on next page)
3
EVALUATION OF APPLICANT'S PERFORMANCE AND POTENTIAL (cont.)
Please check the box that you feel best characterizes the applicant's abilities.
Ability
Consistently
> 75%
of the time
(4)
Frequently
50-75%
of the time
(3)
Barely
< 25%
of the time
(1)
Unable
to
Observe
1. Lab performance:
Organizes work logically and for efficiency; does work promptly,
independently, and thoroughly
2. Judgment:
Critically and reliably evaluates facts; uses good common sense
3. Initiative:
Completes assignments; seeks direction when needed; sees what
needs to be done and takes appropriate action
4. Written communication:
Expresses written ideas clearly using proper English
5. Oral communication:
Expresses verbal ideas clearly using correct English
6. Development potential:
Appears to have potential for professional growth
7. Leadership:
Has ability to assume responsibility; organizes team projects;
promotes collegiality; is accountable for performance
8. Problem solving ability:
Uses logical thought processes; is able to transfer learning from
one situation to another
9. Adaptability:
Has ability to evaluate new or changing conditions; displays ability
to accept criticism and profits from suggestions; readily admits
mistakes and takes immediate steps to correct them
10. Interpersonal relations:
Works well with others in a team sense; communicates in a mature
manner; cooperates and interacts appropriately with peers and
authoritative figures , e.g., faculty
11. Attendance/punctuality:
Arrives on time and prepared for class
TOTAL
Signature of Evaluator: Date:
Please PRINT Evaluator's Name:
Please PRINT Evaluator's Title:
College/University/Institution & Position: ______
Address:
Telephone: ( )
(Type name)
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REQUEST FOR LETTER OF RECOMMENDATION (Northern Illinois University)

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Completed 12 January 2021

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