Student Evaluation Form

Name of student :   ___________________________________________________________
                                          LAST			    FIRST                                                MIDDLE
  
Desired major :      ___________________________________________________________             

I, _________________________, hereby waive my right of access to this reference report.

Respondent's Name :   _________________________________________________________

Title : 	                                                            Department :  

Institution :    ________________________________________________________________

Address :       ________________________________________________________________

•	How do you rate the applicant in comparison with his peers?

	Exceptional
(Top 5%)	Outstanding
(Top 10%)	Above Average
(Top 25%)	Average
(Top 50%)	Below Average
(Lower 50%)	Insufficient
Information	
Intellectual Ability							
Academic Achievements							
Communication Skills
(Oral)							
Communication Skills
(Written)							
Aptitude for Graduate Studies							
Imagination and Creativity							
Potential as a Teacher							
Potential in Research							
Maturity And Stability							

•	Summary evaluation of the student’s ability to handle a graduate program :

•	
•	Strongly Recommended
•	Recommended
•	Recommended with Reservation
•	Not Recommended

   Respondent's Signature :  					Date :