Evaluator:

The LSUS/LSUHSC-Shreveport MPH Program would like to thank you for taking time to complete your recommendation on this applicant.

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* 1. Please type the name of the applicant your are referring for the MPH Program:

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* 2. Your Name and Title:

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* 3. Your Occupation:

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* 4. Your Organization:

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* 5. Your email:

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* 6. How long have you known the applicant?

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* 7. How Well do you know the applicant?

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* 8. In what capacity do you know the applicant?

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* 9. Please rate the following characteristics for this applicant:

  Not Observed Below Average Average Above Average Excellent
Adaptability
Empathy
Ethics
Intellectual Ability
Interpersonal Relationships
Judgement
Leadership
Oral Communication - English
Professional Appearance
Reliability
Written communication - English

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* 10. What is your recommendation concerning the applicants admission to the program?

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* 11. Please use the space provided to supply any additional information on the applicant:

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