Vanderbilt Program of Medical Laboratory Science

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:

 phillip.b.denton@vanderbilt.edu 

Evaluation

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.

PLEASE ADD ANY SPECIAL COMMENTS:

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

 Evaluator's name (please print) _________________________________________

 Evaluator's contact information _________________________________________

                          address, phone__________________________________________

                   email (not required)__________________________________________

               Evaluator's Signature__________________________________________ 

                                          Date__________________________________________

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