# ![](media/image1.jpeg){width="0.8020833333333334in" height="0.5625in"}Plum Island Animal Disease Center

*Research Participation Program*

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

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| **     |                    |                     |                 |
| Applic |                    |                     |                 |
| ant:** |                    |                     |                 |
+--------+--------------------+---------------------+-----------------+
|        | *(Last Name)*      | *(First Name)*      | *(Middle Name)* |
+--------+--------------------+---------------------+-----------------+
|        |                    |                     |                 |
+--------+--------------------+---------------------+-----------------+
| **How  |                    |                     |                 |
| long   |                    |                     |                 |
| and in |                    |                     |                 |
| what   |                    |                     |                 |
| assoc  |                    |                     |                 |
| iation |                    |                     |                 |
| have   |                    |                     |                 |
| you    |                    |                     |                 |
| known  |                    |                     |                 |
| the    |                    |                     |                 |
| appl   |                    |                     |                 |
| icant? |                    |                     |                 |
| Thesis |                    |                     |                 |
| /      |                    |                     |                 |
| Disser |                    |                     |                 |
| tation |                    |                     |                 |
| Adv    |                    |                     |                 |
| isor** |                    |                     |                 |
|        |                    |                     |                 |
|        |                    |                     |                 |
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How would you rate the applicant with respect to the following
**PERSONAL CHARACTERISTICS**?

  ----------------------------- ----------- ------------- ----------- ----------------- -------------- ------------
                                **Below     **Average**   **Above     **Outstanding**   **Superior**   **No Basis
                                Average**                 Average**                                    for
                                                                                                       Judgment**

  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                                                                                 

  Work Ethic *(punctuality,                                                                            
  reliably completed tasks,                                                                            
  worked assigned hours/days)*                                                                         
  ----------------------------- ----------- ------------- ----------- ----------------- -------------- ------------

How would you rate the applicant with respect to the following
**SCIENTIFIC CAPABILITIES**?

  ----------------------------- ----------- ------------- ----------- ----------------- -------------- ------------
                                **Below     **Average**   **Above     **Outstanding**   **Superior**   **No Basis
                                Average**                 Average**                                    for
                                                                                                       Judgment**

  Mastery of fundamental                                                                               
  knowledge in field                                                                                   

  Skill/originality of research                                                                        
  project design                                                                                       

  Laboratory skill and                                                                                 
  technique                                                                                            

  Ability to communicate                                                                               
  *(written/oral)*                                                                                     

  Organizing and tracking data                                                                         

  Quality of Work *(projects                                                                           
  and tasks completed with                                                                             
  attention to details, few                                                                            
  errors in work, followed                                                                             
  directions)*                                                                                         
  ----------------------------- ----------- ------------- ----------- ----------------- -------------- ------------

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  Applicant Name:          

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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.

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  Name:                                    Title:        

  Address:                                 Phone:        

                                           Fax:          

  Email:                                            
  ---------- ----------------------------- -------- ----------------------------

**For E-mail submitted reference form:**

I hereby certify that that the above information is correct to the best
of my knowledge and contains no false or fraudulent representations,
statements, or entries.

**For reference form sent by mail or fax:**

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  Signature                                        Date
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**Mail to: Fax to:**

Plum Island Animal Disease Center (631) 323-3006

PO Box 848

Greenport, NY 11944-0848 **Email:**

Attn: PIADC Research Participation Program piadc@orau.org

If sent via e-mail, if must come from an e-mail account that is named in
such a way that it is obvious the e-mail account is owned by the person
submitting the form.