application form

teacher and counselor recommendation form
HHMI Summer Programs : Recommendation Form
June 22-28, 2008

Please complete this form before March 31, if possible, as review of applications will begin on that date.

The information you provide will be held in the strictest confidence.

 

Candidate Name
LastFirst
School
How long have you known this student?
 
Please describe the extent and quality of your relationship to the student
 

Please describe the student's strengths and weaknesses of character, ability, and personality as you know them.
 

How would participation in The Art and Science of Medicine be particularly beneficial for this student?
 

Are you aware of any reason the applicant should not participate in this program?
 

In what ways has the student demonstrated special ability and interest in science? Please be as specific as possible.
In school:
Outside of school

Do you believe that this student's grades accurately reflect her/his abilities? (Please explain, if appropriate.)
 
Additional comments
 
Your Name:
Role: Teacher    Counselor
School:
Phone Number ( )
Verification CodeIMAGE Enter the verification code as it is shown to the left. If you cannot read the code refresh your browser to try a different one.

Printable forms

Teacher Form

Counselor Form

If you prefer to print this form and fill it out by hand, please choose the appropriate link and mail the completed form to :

Dr. Regina Stevens-Truss
Art and Science of Medicine
Kalamazoo College
1200 Academy St.
Kalamazoo, MI 49006-3295