Division of Consolidated Laboratory Services Internship Reference Form: Summer 2026

To be completed by an academic or professional with knowledge of the applicant.

INSTRUCTIONS FOR COMPLETION: You may save your progress and resume at a later time from the same device by clicking "Next".

Reference Deadline: January 11th, 2026 11:59 PM EST

This reference is being offered for an applicant interested in a public health laboratory internship at the Commonwealth of Virginia Department of General Services Division of Consolidated Laboratory Services (DCLS).

DCLS internships are project-oriented and designed to be mutually beneficial to the intern and the laboratory. DCLS internships provide a unique opportunity to gain hands-on experience in one of the most diverse public health laboratories in the nation.

The applicant has given your name as a reference. To complete this reference please provide the four-digit PIN Number given to you by the applicant.

Rate the applicant with respect to each of the qualifications listed.

Provide a description of your estimation of this applicant’s qualifications.

Thank you in advance for your honest assessment of the applicant.

Question Title

* 1. Provide the Legal Name for the Student/Applicant (Reference for):

First Name

Last Name

Division of Consolidated Laboratory Services Internship Reference Form: Summer 2026

To be completed by an academic or professional with knowledge of the applicant.

Question Title

* 1. Provide the Legal Name for the Student/Applicant (Reference for):

Question Title

* 2. Applicant Preferred Name (If different from above)

Question Title

* 3. Four (4) Digit PIN provided by the Applicant