SORT Performance Appraisal Form

Applicants for the Baton Rouge General School of Radiologic Technology are required to submit a minimum of two (2) completed Performance Appraisal Forms for the Admissionsyear that they are applying. More than two (2) are allowed but 2 is the minimum required for the application process for the applicant to be considered complete.

This 2025 Performance Appraisal Form is being sent to you to complete as a request to validate current skill or competence levels and evaluate the applicant for BRG SORT Admissions to the Professional Program in Radiologic Technology (Medical Imaging) for the Class of 2027 (Admissions starting Jan 2026). To serve as an Evaluator for the Applicant, you must have been an Employer (Supervisor or above), Direct Supervisor, or a College Instructor/ Professor/ Clinical Coordinator/ Director/ Dean of the Applicant within the past 2-4 years.

By sending this form for the Evaluator to complete, the applicant agrees to waive their rights to the completed Performance Appraisal Form by the individual completing it below. The applicant and the evaluator also should know and understand that the Form will ONLY
be viewed by the SORT Program Director and 2025 Admissions Committee. It is the BRG SORT Admission Committee's request that the form below be completed for the applicant with caution, critical and clear recommendation evaluation, and the most accurate understanding of the applicant's abilities within the setting that they are applying to. The medical environment is one that requires good written and oral communication, excellence in appearance and hard work, and quality critical thinking for the success of the patient's outcome. This program that the applicant is applying for is 2 years full time and is rigorous in academic standards. We strive to create and continue the tradition of excellence within each student group through graduation and successful national boards testing. Our ultimate goal is to provide quality entry level professionals to the medical community that represent the program well. This Performance Appraisal Form for the applicant is designed
to assist the Admissions Committee in doing just that for each admissions year.

Please complete the entire BRG SORT Performance Appraisal Form below and submit before the deadline of 8/29/25 at 4pm for this to be included within the Applicant's Master file for the Admission year of 2025 (Class of 2027). Any form that is not submitted by the deadline or is submitted incomplete will NOT be included or counted for the Applicant. If you as the evaluator, would like to submit additional information (positive or concerns) to
the BRG SORT Admissions Committee regarding the applicant. Please feel free to email the Program Operations Coordinator, Langley Britt, directly at
Radiologyschool@brgeneral.org at any time.

NO Performance Appraisal Forms should come directly from ANY Applicant- this will VOID the FORM and will be referred to the Program Director for violation of the Admissions Process.

You will receive an email following the completion of this Form with your responses for your records. We may contact you (via email or phone) for additional clarification or verification of completion if necessary, with parameters of evaluation submitted on applicant. We appreciate your help with this evaluation of the applicant and assistance within the application process for Baton Rouge General School of Radiologic Technology!

Deadline for submission of this Form: 8/29/25 at 4pm

Please email Langley Britt- BRG SORT Program Operations Coordinator, if you have any questions or need help in completing at Radiologyschool@brgeneral.org.

Email*

example@example.com

Name of Individual Completing this Form (Evaluator)*

First NameLast Name

Name of Applicant*

First NameLast Name

Mailing Address of the Evaluator (Address will be used for thank you letter only)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number for Evaluator (will only be used for clarification or verification if needed)*

Please enter a valid phone number.

In what capacity have you, as the Evaluator, known the Applicant? (Select all that apply)*

Prior Educator (College Instructor, Professor, Clinical Faculty, or Program Director- at least 1 academic course)Current Educator (College Instructor, Professor, Clinical Faculty, or Program Director at least 1 academic course)Prior or Current Faculty Advisor (Academic, Professional, or Social Organization; Must be within the past 2 years and for at least 6 months)Prior Employment Supervisor/Manager/Director (must be a higher level than applicant in ranking and must be someone that directly supervised or evaluated the applicant as an employee)Current Employment Supervisor/Manager/Director (must be a higher level than applicant in ranking and must be someone that directly supervised or evaluated the applicant as an employee)I was asked by the candidate to complete this evaluation for them, but do not qualifyunder any of the above listed associations as Evaluator of the Applicant.

How long have you known the Applicant in the above listed capacity?*

Less than 6 months6 months- 1 year (or 1 academic semester)1 - 2 years (2 consecutive academic semesters)More than 2 years but less than 5 years (more than 2 consecutive academic semesters)5 or more years

Personal Characteristics: Comparing the Applicant to others of similarbackground or experience, Please rate the Applicant in EACH of the categories below:*

	Not Appropriate; Have Concerns	Appropriate	Exceeds Peers in Appropriateness
Speech (Oral Communication) and Decorum (Social Engagement/Behavior)
Grooming and Personal Hygiene
Level of Maturity/Self Awareness
Personal Responsibility
Promptness/Meeting Deadlines
Absenteeism
Overall Ability Toward Completion of Given Task

Performance Characteristics: Comparing the Applicant to others of similarbackground or experience, Please rate the Applicant in EACH of the categoriesbelow:*

	Inadequate	Below Average; Meets Minimum	Average	Above Average	Excellent, Top Performer
Quality of Work
Quantity of Work
Organization or Structure of Work
Written Communication
Learning Skill/Ability to Learn New Things
Ability to Retain Skills Learned and Build on Those
Ability to Work Well with Others/In Team Environment
Flexibility/Ability to Deal with Change
Initiative/ Self-Directed/Resourceful
Ability to Deal with Stress
Time Management/Task Management Under Deadline
Critical Thinking Skills/Ability to Adapt
Ability to Handle Feedback/Constructive Criticism
Ability to Assess Information Given and Perform Quickly and Efficiently

How does the applicant do in problem solving and critical thinking situations? Can they adjust and be resourceful independently? Please provide an example.*

How does the applicant work/perform in stressful or changing environments with moderate demands on time or multitasking? Please provide an example.*

Describe 3 strengths possessed by the Applicant that would have a positive impact in the practice of Radiologic Technology (Medical Imaging) or within Healthcare.*

Describe 1-3 areas of growth (weakness) possessed by the Applicant that would have a negative impact or cause for concern within the practice of Radiologic Technology (Medical Imaging) or within Healthcare as a whole if not addressed and improved by the Applicant over time.*

Overall, how would you rank/rate this Applicant for admissions into a rigorousprofessional program for Medical Imaging/Healthcare as the Evaluator?*

I do not recommend the Applicant for Admission based on my knowledge and experience with them in the capacity mentioned above.I have reservations about recommending the Applicant for Admissions based on my knowledge and experience with them in the capacity as listed above but would recommend them.I recommend the Applicant for Admissions based on my knowledge and experience with them in the capacity mentioned above.I HIGHLY recommend the Applicant for Admissions with the program based on myknowledge and experience with them as mentioned in the capacity above and feel that they would be an excellent addition to this profession/medical practice without a doubt.

Additional Comments/Concerns/Reasons that as the Evaluator the Admissions Committee should consider about the Applicant:

Evaluator's Name, Credentials, and Title

Acknowledgement Statement:
As the Evaluator, your feedback, validation, and evaluation of the Applicant
provided to the Baton Rouge General School of Radiologic Technology
Professional Program will be used strictly by the Admissions Committee for the
review of the Applicant for admissions into the professional program only.
Additionally, the information provided must come directly from one of the
qualified individuals listed above and should never come directly from any
applicant. All information is kept confidential by the program and is only
seen/reviewed by the SORT Registrar and Admissions Committee members. All
information is blinded prior to review by the committee and is used to ensure that
only qualified applicants are admitted to our program to ensure the applicant's
and the program's success long term. Any Evaluator may contact the program to
help provide any additional information as is pertaining to the admissions
process for the healthcare profession. As an evaluator, you may be contacted by
the program to provide any clarification if needed regarding this letter of
Performance Appraisal/Recommendation only. The Applicant has waived their
rights to see the information included within this document by sending this
link/document directly to you to complete on their behalf.

To agree to this understanding and to submit the Performance Appraisal as
completed above, please type in your LEGAL NAME below and the DATE of your
signature. When complete with the evaluation, then select submit.

Legal Name*

Date*

Date

Please allow a few moments for the submission to process after clicking Submit and do not click Submit more than once.

BRG SORT Performance Appraisal Form for Admissions 2025 - Class of 2027