Vanderbilt Program of Medical Laboratory Science

Student Evaluation

Submitting Evaluation Form

In order to complete the application process, please print three copies of the evaluation form and have professors or employers submit them to the following address:

Program of Medical Laboratory Science

 Vanderbilt University Medical Center

4605 TVC                  

1301 Medical Center Drive

Nashville, TN 37232-5310

If you have any questions during this process, please e-mail us at the address below:




For a Word version of this form, click here.

Vanderbilt University Medical Center

Program of Medical Laboratory Science

Student Evaluation

Applicant's name ___________________________ SSN___________________

To the applicant: please sign and date one of the following statements.

1. I wish to have access to this letter and I understand that under the Family Education Rights to Privacy Act of 1974, 20 U.S.C.A. Par. 1323 g(a) (1) and P.L. 397 of 1978, I have the right to read this recommendation


2. I wish this letter to be confidential and I hereby waive any and all access rights granted me by the above laws to this recommendation.



TO THE EVALUATOR: Please rank the applicant based on the following scale: Standards to be used in ranking. 4-excellent, outstanding; 3- above average; 2- average; 1-below average; NA- no basis for judgement.

   3  2  1  NA
Knowledge and Interest in Medical Lab Science          
 Ability to deal with difficult situations          
 Level of commitment to complete a task/goal          
 Ability to work with others          
 Sensitivity to others          
 Ability to analyze a problem or situation          
 Problem solving skills          
 Ability to communicate with others          
 Ability to follow through          
 Planning skills          
 Organizational skills          
 Confidence/Awareness level of strengths and weaknesses          













 SUMMARY: How would you rank this individual as a candidate for admission?


   Excellent, outstanding    Average
   Above average   Below average 

 Evaluator's name (please print) _________________________________________

 Evaluator's contact information _________________________________________

                          address, phone__________________________________________

                   email (not required)__________________________________________

               Evaluator's Signature__________________________________________


Please indicate how long you have known the applicant and in what capacity.


Please return to:

Program of Medical Laboratory Science

Vanderbilt University Medical Center

Room  4605 TVC       

1301 Medical Center Drive

Nashville, TN 37232-5310

This page was last updated July 26, 2013 and is maintained by