LSAMP Student Recommendation Form

The student that shared the link to this form is seeking to become a member of the Louis Stokes Alliance for Minority Participation (LSAMP). The Faculty Council would like your input to help make its decision. Please contact Eunice Wheeler should you have any questions regarding this process.

STUDENT DETAILS

Last Name*

First Name*

YOUR INFORMATION

First Name*

Last Name*

Email

example@example.com

STUDENT PROFILE

How long have you known the student and in what context?

Check the appropriate box that best describes the character of the student.

	Truly Outstanding (top 2-3%)	Excellent (top 10%, but not not top 2-3%)	Good	Average	Below Average	No basis for judgment
responsibility
maturity and self-discipline
self-confidence
leadership
concern for others
integrity
reaction to setbacks
compliance with school regulations
cooperation with others
overall

If you consider the student to be particularly strong or weak in any of the above, please elaborate:

Recommendation

recommend without reservationrecommend with reservation (please comment)do not recommend (please comment)

Comments

Name (valid as paper and pen signature)*

Date*

Date