Center of Excellence Health Sciences Scholar Institute (HSSI) 2017 Recommendation Form (To be completed by a current teacher, counselor, school administrator or community leader)
Please type or print legibly Michigan State University College of Human Medicine is pleased to offer an exciting summer opportunity to current 10th and 11th grade high school students with a minimum GPA of 3.0 who have a strong interest in becoming a physician. The dates are July 10 – August 4, 2017. We are looking for competitive, highly motivated, and college focused students who are underrepresented in the field of medicine. If you know of an outstanding student to recommend who meets the criteria, we are asking for your candid feedback regarding the student’s performance in school and level of readiness for the Health Sciences Scholar Institute. Student Name: Completed by: Email: Title:
Phone:
How long have you known this student?
0-1 years
2-5 years
6 or more
Please place a check mark to indicate your evaluation of the student named above based on the student’s performance for each of the criteria listed below. Below Criteria Outstanding Good Average Average Interest in becoming a physician Completion of assignments on time Ability to work independently Ability to work with others Self-motivated to excel Personal conduct/behavior in classroom Problem solving & critical thinking skills Self-discipline as a learner Class attendance Class participation Additional comments:
Please place a check mark in the box to indicate your overall evaluation of this student’s interest and readiness for a Health Profession enrichment program. Outstanding
Good
Signature *
Average
Below Average
Date
Please submit the completed for to Mrs. Theresa Blanks at
[email protected], fax to 517-432-1051 or send to Health Sciences Scholar Institute, Michigan State University College of Human Medicine, 1355 Bogue Street, Room B-209, East Lansing, MI 48824 no later than 5:00 p.m., Friday, May 26, 2017. * Your email will serve as your electronic signature.
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