Robert Noyce SMART Affiliate Program
Reference Form
Applicant’s Name: ________________________________________
The person whose name appears at the top of this form is an applicant for the NSF funded CWU Robert Noyce
SMART Affiliate program that is intended for first and second year science or mathematics majors who wish to
explore a teaching career in mathematics or science. The Noyce SMART Affiliate Selection Committee would
like your help in determining this candidate’s suitability for our program.
Ideal candidates demonstrate academic leadership characteristics, a desire to increase their knowledge of and
skill in mathematics, science, or education, and a disposition appropriate for teaching. Please complete both
sides of this form. Thank you for your help.
In what capacity do you know the applicant? ________________________________________
How long have you known the applicant? ___________ years ___________ months
Please complete Page 2 of the Reference Form and then use this space to make any additional comments or
attach a separate page with comments:
________________________________________
When completed, please print, sign and then mail this reference form to:
CWU Noyce SMART Affiliate Program Selection Committee
Center for Excellence in Science and Mathematics Education
Attn: Martha Kurtz
400 E. University Way
Ellensburg, WA 98926-7519
Rev: 01-19-2016
Center for Excellence in Science and Mathematics Education
400 East University Way . Ellensburg WA 98926-7519 . Office: 509-963-3002
EEO/AA/TITLE IX INSTITUTION • TDD 509-963-2143
Please carefully review the following scale values and then, at the end of each statement, respond by placing an ‘X’ in
one scale value box in accordance with your direct observation of the applicant. Please use a dark pen and mark clearly.
Scale Value:
5
4
3
2
1
Exceptional
Sufficient to consider becoming a teacher
Could consider becoming a teacher with improvement
Not sufficient to consider becoming a teacher
No basis for judgment
1
2
3
4
5
Oral communication: uses language accurately and communicates clearly and
concisely.
Witten communication: writes in a manner that is clear and grammatically correct.
Listening skills: listens attentively and demonstrates understanding of what was heard.
Reading skills: comprehends written instructions and complex written information.
Critical thinking: analyzes, synthesizes, and applies information to solve problems.
Content knowledge: possesses appropriate content knowledge and can apply it to real
world contexts.
Pedagogical skill: demonstrates the potential to teach math or science.
Empathy: demonstrates concern for people in various situations.
Tolerance: can accept the views of others and integrate them with own views.
Open-mindedness: views problems from varying perspectives.
Self-confidence: demonstrates faith in convictions in the face of adversity.
Organization: identifies specific tasks, collects appropriate information and generally
functions in a logical and productive manner.
Initiative: identifies what needs to be done in situations and does it promptly, without
direction.
Time management: organizes time so that tasks undertaken are completed in
accordance with a predetermined or accepted schedule.
Persistence: after having identified specific tasks, continues to pursue those tasks until
they are accomplished.
Attendance and punctuality: consistently keeps appointments and arrives on time.
Leadership: helps others to accomplish specifically identified tasks through direction
and example.
Creativity: able to generate new ideas and think “outside the box.”
Willingness to accept constructive criticism: considers the suggestions of others and
uses them, as appropriate, to improve.
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Recommender’s Name
_____________________________________
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Signature
Date
______________________________
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Title
Institution
______________________________
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Phone
Email
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