2013 AS&S Institutional Staff Recommendation Form Survey: Nepal

...................INSTITUTIONAL STAFF INFORMATION....................
Suggestion:
For each recommended student, some of the fields in this section may have to be re-entered, e.g. School Name. In order to facilitate the process, consider using a text editor to contain the repeated information. Then use copy and paste to enter the repeated information into the appropriate fields.

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* 1. Type of Institute

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* 2. School/College/University/Institute Name

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* 3. Recommending Staff Member Name

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* 4. Gender

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* 5. Recommending Staff Member Title

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* 6. Recommending Staff Member Email Address

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* 7. Recommending Staff Member Phone Number

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* 8. Recommending Staff Member Position

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* 9. Recommending Staff Member Field and Subject of Research

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* 10. Recommending Staff member affiliation to Research/Scholastic/Educational Society

...........RECOMMENDING STUDENT CANDIDATE INFORMATION.........

Suggestion:
Enter details regarding your recommendation of a student candidate. The recommended student will be referred to as "Candidate."

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* 11. Candidate's Full Name

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* 12. Gender

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* 13. Candidates Email Address

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* 14. Candidate's Age & Date of Birth(DOB) (in Yrs.)

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* 15. Candidate's Religion

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* 16. Candidate's Caste

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* 17. Candidate's Membership in AS&S

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* 18. If Candidate is a current member of AS&S, provide their Entering Year

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* 19. Candidate's Grade Level/Rank/Class/Percentage of marks obtained in the current or last Exam/Assessment.

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* 20. On what grade scale/ percentage out of?

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* 21. Candidate's Class Rank

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* 22. Total Class Strength/Enrollment.

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* 23. List Advanced placement Level Courses taken by Candidate (If Applicable)

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* 24. List talent and gifted programs Candidate is enrolled ( If Applicable)

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* 25. Please use the 5-level rating scale to evaluate the student’s performance relative to other students with whom you have worked

  Below Average Average (Top 50%) Good (Top 25%) Excellent (Top 5%) Outstanding (Top 2%)
Factual Knowledge
Imagination/Creativity
Tenacity/Effort
Learns Information Quickly
Self-Confidence
Work Ethic/Accountability
Works well with peers
Discipline
Class Attitude
Attendance/Punctuality
Likes to solve difficult problems
Communication: Oral
Communication: written
Leadership Qualities
Research Interest
Academic Interest
OVERALL

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* 26. Candidates Family Status (State whether BPL-Below poverty line or APL-Above poverty line)

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* 27. Please Provide Candidate's and/ or Family's Citizenship Number

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* 28. I certify that I have responded to the best of my understanding with respect to recommending the above-described candidate for membership in the Association of Science and Society(AS&S).

Please type the following text and your name as follows: I, (your name), have completed this form and agree to the above.

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* 29. Date Completed

Date
Please review all your responses before submitting your responses. Note: fields that MUST be answered (i.e. marked with an *) and fields with improper syntax, (e.g. emails without an @) will be flagged with explanatory text and submission will not go through until the flagged entries are corrected.
© MMX by Association of Science and Society(AS&S) and Harlem Children Society(HCS).
All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of Association of Science and Society(AS&S) and Harlem Children Society(HCS).

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