# ORISE Research Participation at the CDC

**Reference** *(A letter may be substituted, if more convenient.)*

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  **Applicant:**                                                

                   *(Last Name)*         *(First Name)*         *(Middle Name)*

  **How long and                                                
  in what                                                       
  association have                                              
  you known the                                                 
  applicant?                                                    
  Thesis                                                        
  /Dissertation                                                 
  Advisor \[ \]\                                                
  **                                                            
  ---------------- --------------------- ---------------------- ------------------

In a group of 100 science and math students of comparable age and
experience, how would you rate the applicant with respect to the
following **PERSONAL CHARACTERISTICS**?

  ----------------------------- ----------- ----------- ----------- --------------- ------------ ---------------
                                **Below     **\         **Above     **\             **\          **Inadequate
                                Average**   Average**   Average**   Outstanding**   Superior**   Observation**

  Motivation toward a                                                                            
  productive career                                                                              

  Growth during total period                                                                     
  observed                                                                                       

  Imagination and originality                                                                    
  of thought                                                                                     

  Emotional maturity and                                                                         
  stability                                                                                      

  Ability to work with others                                                                    

  Independence and                                                                               
  self-reliance                                                                                  

  Leadership potential                                                                           
  ----------------------------- ----------- ----------- ----------- --------------- ------------ ---------------

In a group of 100 science and math students of comparable age and
experience, how would you rate the applicant with respect to the
following **SCIENTIFIC CAPABILITIES**?

  ----------------------------- ----------- ----------- ----------- --------------- ------------ ---------------
                                **Below     **\         **Above     **\             **\          **Inadequate
                                Average**   Average**   Average**   Outstanding**   Superior**   Observation**

  Mastery of fundamental                                                                         
  knowledge in field                                                                             

  Skill/originality of research                                                                  
  project design                                                                                 

  Laboratory skill and                                                                           
  technique                                                                                      

  Ability to communicate                                                                         
  (written/oral)                                                                                 
  ----------------------------- ----------- ----------- ----------- --------------- ------------ ---------------

Add any descriptive comments that will assist in providing a complete
picture of the applicant's character, attitude, abilities, and potential
for research. Please comment on both the applicant's weak and strong
points. Use additional sheets if necessary.

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  **COMMENTS:**                              

  Signature:                                 Date:

  Typed/Printed Name:                        Title:

  Address:                                   Phone:
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**Mail documents to:**

Andrea Hines, Program Analyst/Assisting Intern Coordinator; Public
Health Law Program, CDC; 1600 Clifton Road, NE  Mailstop D30, Atlanta,
GA  30333