The Ohio State University Department of Surgery

NIH T32 “Advanced Research Training in Immunology for Surgical Trainees/ ARTIST”

Program Director Evaluation

SECTION ONE: To be completed by applicant

Name (print): ______

Last First Middle

OSU ID # ______Academic Department ______

The Family Educational Rights and Privacy Act of 1974 and its amendments guarantee students access to their educational record. Students, however, are entitled to waive their rights of access concerning recommendations so recommenders can give feedback that is held in confidence.

Please check one, sign and date:

□  I waive my right of access to this evaluation: ______

□  I do not waive my right of access to this evaluation: ______

If the waiver is unsigned, the law specifically reserves the right of access to this student

SECTION TWO: To be completed by applicant’s Graduate Program Director

The OSU ARTIST Training Program would appreciate a candid evaluation of the student names above. Please rank the student in the categories below by placing an “X” on the scale in the appropriate area.

Please identify the group to which the applicant is being compared ______

(i.e. current or recent students in your dept.)

Lowest 50% / Top 50% / Top 25% / Top 10% / Top 5% / Unable to Rate
Ability to learn
Creativity / Innovation
Written expression
Oral expression
Dedication to research career path
Potential in research
Potential to benefit from ARTIST training
Leadership
Accuracy and Quality of work
Dependability
Self-Reliance
Perseverance towards goals

Please attach a separate page for any additional comments you would like to make:

Please check one:

□  Recommend enthusiastically Signature: ______

□  Recommend with confidence Name (print) ______

□  Recommend

□  Recommend with reservation Please return form by September 15, 2014 to:

□  Not recommended Anna Patterson