UCLA Chemistry-Biology Interface Training Program
Application 2015-2016
Return to:
Rachael Pease, Program Administrator
Department of Chemistry and Biochemistry
4505A Molecular Sciences Building, 156905
University of California, Los Angeles
Los Angeles, CA 90095-1569
maynardadmin@chem.ucla.edu
Applicant’s Name:
You have been selected as a reference by the aforementioned applicant for a period of study funded by the NIH. Please complete this
inquiry and return it to the address printed above before May 27, 2015
1. Rate the applicant on the items below by a numerical score of 1 to 5 (1 = highest), basing your ratings of the level of
accomplishment you usually expect of individuals at this level:
1 = outstanding
2 = above average
3 = average
A.
B.
C.
D.
E.
Originality
Accuracy
Research Ability
Scientific Background
Ability to Exchange Ideas
4 = below average
5 = poor
X = insufficient knowledge to rate
F.
G.
H.
I.
J.
Perseverance in Pursuing Goals
Ability to Organize Scientific Data
Familiarity with Research Literature
Proficiency in Laboratory Work
Ability to Write Journal Articles
2. Describe any qualifications and traits you consider of special significance in judging the applicant’s fitness for a research career.
List major academic weaknesses, if any. (Use a separate page if necessary.)
3. How long have you known the applicant?
4. In what capacity have you known the applicant?
Name of Evaluator:
Department:
Address:
Title:
Institution:
Phone:
E-mail:
Evaluator’s Signature
Date