TSHP Research & Education Foundation Internship Reference

The applicant appearing below has selected you as a reference. Your comments are very important to our selection process and we would appreciate receiving your evaluation before February 6, 2009.   Please return the evaluation form directly to:

TSHP R&E Foundation

Internship Programs
3000 Joe DiMaggio #30-A

Round Rock, TX 78665-3994

Please print or type

Applicant's Name: __________________________________________________________________________________________

(Last) (First) (Middle)

Mailing Address: ________________________________________________________________________________

Name of Reference: ______________________________________________ Position: ______________________________

Institution: ______________________________________________________ Telephone:(______)____________________

Mailing Address: ________________________________________________  E-Mail: ____________________

Please evaluate the applicant relative to all students with whom you are associated:

1) How well do you know the applicant? (Well) (Moderately Well) (Very Well)

2) How would you rate the applicant's communication skills? (Poor ) (Good) (Superior )

3) How would you rate the applicant's appearance? (Poor ) (Good) (Superior )

4) How would you rate the applicant's ability to get along with peers and other individuals? (Poor ) (Good) (Superior )

5) How do you rate the leadership skills of this applicant? (Poor ) (Good) (Superior )

6) How would you rate the applicant's ability to generate or grasp new ideas? (Poor ) (Good) (Superior )

7) To what extent has the applicant been active in student associations such as SAPhA,

professional or social fraternities, councils, etc. (Poor ) (Good) (Superior )

8) Do you recommend the applicant for the internship program? (Yes ) (No) (Yes with reservations)

*Please use the reverse side of this form to expand on any of the above items or to provide supplemental information that would enable us to fairly evaluate this applicant. Thank You.