University of New Mexico MD/PhD Fall 2015 Applicant Evaluation
Applicant: By entering your name below, you agree to the following statement:
I agree to waive my right of access to the letter of recommendation and evaluation. I understand that the letters of
recommendation and the evaluations will remain confidential.
If you wish to retain your rights to access the letter of recommendation and evaluation, please contact Mary Fenton at
mfenton@salud.unm.edu for further instruction and do not forward this form to your referees.
Applicant: Please enter your name. (Required)
Click here to enter text.
Three letters of recommendation are required. Please forward this form to each of the individuals who will be providing a
recommendation.
1. To the Referee: Welcome to the UNM MD/PhD Applicant Evaluation
PRIVACY
In accordance with the Family Educational Rights and Privacy Act of 1974 (FERPA), the applicant has agreed to waive his/her rights to
access the information provided by his/her referees, and understands that the information provided will remain confidential.
DEADLINE
The applicant who has requested this evaluation and letter of recommendation is trying to meet a November 15 deadline.
QUESTIONS OR CONCERNS
If you have any questions or concerns about the Letter of Recommendation or the applicant evaluation, please email Mary Fenton,
MD/PhD Admissions Coordinator, at mfenton@salud.unm.edu.
We sincerely appreciate your time and consideration in providing a reference for this applicant.
2. Contact Information
Please provide your contact information, using your official institutional email and url. Personal web sites will not be sufficient
credentials.
We understand that some international faculty members prefer to use a publicly available email provider instead of the institution's
email provider. If this is the case, we must be able to verify the email address through the institution's official web site.
1. Please provide your professional contact information. (Required)
Name: Click here to enter text.
Title/Position: Click here to enter text.
Institution/Company: Click here to enter text.
Address: Click here to enter text.
City: Click here to enter text.
State/Province: Click here to enter text.
ZIP/Postal Code: Click here to enter text.
Email Address: Click here to enter text.
Phone: Click here to enter text.
3. The Nature of Your Relationship with the Applicant
1. How long have you known the applicant? Please indicate the time period (dates) during which you were acquainted with the
applicant. (Required)
Click here to enter text.
2. What is the nature of your relationship with the applicant (i.e., research mentor, professor, supervisor, etc.)? (Required)
Click here to enter text.
4. Evaluation of Skills
The evaluation questionnaire portion of this survey is heavily weighed during the Admission Committee's consideration of the
applicant.
Please rate the applicant's skills in the following areas.
1. Research Skills
Please rate the applicant's laboratory and research skills, relative to others at his or her level of experience. (Required)
Excellent
Very Good
Above Average
Average
Below Average
Inadequate
opportunity to
observe
Technical
skills/laboratory
technique
☐
☐
☐
☐
☐
☐
Curiosity
☐
☐
☐
☐
☐
☐
Originality and creativity
☐
☐
☐
☐
☐
☐
Indication of individual
research potential
☐
☐
☐
☐
☐
☐
Ability to conduct
independent research
☐
☐
☐
☐
☐
☐
Performance on a
special project he/she
has worked on with you
☐
☐
☐
☐
☐
☐
Potential for performing
biomedical research
☐
☐
☐
☐
☐
☐
2. Academic Ability
Please rate the applicant's academic ability. (Required)
Excellent
Very Good
Above Average
Average
Below Average
Inadequate
opportunity to
observe
Intellectual ability
☐
☐
☐
☐
☐
☐
Critical thinking ability
☐
☐
☐
☐
☐
☐
Work/study ethic
☐
☐
☐
☐
☐
☐
General knowledge
☐
☐
☐
☐
☐
☐
Knowledge in his/her
chosen field
☐
☐
☐
☐
☐
☐
Quality of publications,
abstracts, or other
research presentations
☐
☐
☐
☐
☐
☐
Ability to assimilate
information from a
variety of disciplines
☐
☐
☐
☐
☐
☐
3. Medical and Graduate School Preparedness
Please evaluate the applicant's preparedness for graduate school. (Required)
Excellent
Very Good
Above Average
Average
Below Average
Inadequate
opportunity to
observe
Potential to succeed in
medical/graduate school
☐
☐
☐
☐
☐
☐
Motivation to pursue a
combined MD/PhD
degree
☐
☐
☐
☐
☐
☐
Mastery of required
background information
for medical/graduate
school
☐
☐
☐
☐
☐
☐
Maturity
☐
☐
☐
☐
☐
☐
Emotional stability
☐
☐
☐
☐
☐
☐
Desire and ability to
synthesize new
interdisciplinary ideas
and concepts
☐
☐
☐
☐
☐
☐
Clarity of goals for
medical/graduate school
☐
☐
☐
☐
☐
☐
4. Personal and Interpersonal Skills
Please evaluate the applicant's personal and interpersonal skills.
Excellent
Very Good
Above Average
Average
Below Average
Inadequate
opportunity to
observe
Ability to express
himself/herself in oral
discussion/presentation
☐
☐
☐
☐
☐
☐
Ability to express
himself/herself in
writing
☐
☐
☐
☐
☐
☐
Effective communication
with others
☐
☐
☐
☐
☐
☐
Independence/selfreliance
☐
☐
☐
☐
☐
☐
Ability to work
effectively in a group
☐
☐
☐
☐
☐
☐
Reliability
☐
☐
☐
☐
☐
☐
5. Comparison
How would you rate this applicant in comparison to other individuals of the same level at your institution?
If you were the applicant’s mentor while he/she was an undergraduate student or intern in your laboratory, please rate the
applicant in comparison to other undergraduate students or interns you have hosted in your lab.
1. Please rate the applicant against others at the same level. (Required)
Choose:
Top 1%
Top 5%
Top 10%
Top 20%
Top 30%
Top 40%
Top 50%
Bottom 50%
☐
☐
☐
☐
☐
☐
☐
☐
6. Narrative Evaluation (Letter of Recommendation)
Please provide a narrative of any additional information you feel would be helpful for the Admissions Committee to know as they
evaluate this candidate's application. (Required)
You may attach the letter to this evaluation and submit both via postal mail, fax, or email. When sending via post, sign your name
diagonally across the seal of the envelope.
Postal mail:
MD/PhD Program
Attn: Mary Fenton
MSC08 4560
1 University of New Mexico
Albuquerque, NM 87131
Or, fax to: 505-272-2412
Or, email as an attachment to:
mfenton@salud.unm.edu