RECOMMENDATION FORM

(To applicant: Please complete the upper portion of the recommendation form and forward it to a person who is familiar with your professional work, or to a college or graduate faculty member who is acquainted with your academic record.)

Applicant’s Name:

Last nameFirst nameMiddle name

Email:

You may waiver the right of access to your recommendation form in order to provide confidentiality to your references. If you wish to waive your right to examine this evaluation, please sign here.

Applicant’s signature: Date:______

_____

TO THE PERSON COMPLETELING THE RECOMMENDATION FORM:

Please rank the applicant in comparison with others applying for a graduate-level certificate program.

In addition to the completed chart below, a written statement is essential to our evaluation of this applicant.

Top 5% / Top 10% / Top 20% / Top 50% / Unable to Assess
Breadth of general knowledge
Quantitative/Analytical ability
Ability to work with others
Emotional Maturity
Ability to carry out individual research
Promise as a public health researcher/practitioner
RECOMMENDATION FORM, cont’d

Please mark one:

  • Recommend enthusiastically Signature:
  • Recommend with confidenceName (Print):______
  • RecommendedTitle and Department:______
  • Recommended with reservationInstitution:______
  • Not RecommendedAddress: Telephone: ______

Email Address:

WRITTEN STATEMENT

The Johns Hopkins School of Public Health would appreciate a candid statement from you concerning this applicant. In your written statement please be sure to comment on the following:

  • How long have you known the applicant, and in what capacity
  • What you consider to be the applicant’s strengths and talents
  • Any weakness that may impede the applicant’s ability to pursue rigorous graduate study
  • How much thought you feel the applicant has give to study public health
  • English proficiency, if the applicant’s native language is not English
  • The ratings you have assigned in the chart above
  • Any additional comments about the applicant’s record, potential, or personal qualities that you feel would be helpful to the admissions committee.

Please use the reverse side of this sheet or an attached letter for your written statement.

Please return completed form and written statement promptly to:

Center for American Indian Health

Attn: Training and Scholarship Program

621 N. Washington Street

Baltimore, MD 21205

Phone: 410-955-6931

Fax: 410-955-2010

If you have any questions, please contact Nicole Paré at the Center at 410-955-6931 or

Thank you for providing this information.