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| **NATIONAL LIBRARY OF MEDICINE**                                      |
|                                                                       |
| **ASSOCIATE FELLOWSHIP PROGRAM**                                      |
|                                                                       |
| **REFERENCE FORM**                                                    |
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Please type or print clearly and return both parts to the Oak Ridge
Institute for Science and Education (fax number below).

  ------------- -- -------- ----- ------------- ------------ ------------ -----------
  Applicant's                                                             
  Name:                                                                   

                   Last                                                   
                   First                                                  
                   Middle                                                 

  How long and                                                            
  in what                                                                 
  capacity have                                                           
  you known the                                                           
  applicant?                                                              

  Length of                 I am: Faculty       Instructor ( Supervisor ( Other ( )
  time:                           Advisor ( )   )            )            
  ------------- -- -------- ----- ------------- ------------ ------------ -----------

**Part 1. Rating Scale:** In a group of 100 other library school
students or persons of comparable experience, how would you rate the
applicant with respect to the following [characteristics]{.underline}:

+----------------------------+------+------+------+------+------+------+
|                            | > B  | >    | > A  | >    | >    | > In |
|                            | elow |  Ave | bove |  Out | Supe | adeq |
|                            | >    | rage | >    | stan | rior | uate |
|                            | >    |      | >    | ding | >    | >    |
|                            |  Ave |      |  Ave | >    | (top |  Opp |
|                            | rage |      | rage | (top | >    | ortu |
|                            |      |      |      | >    |  5%) | nity |
|                            |      |      |      | 25%) |      | > to |
|                            |      |      |      |      |      | >    |
|                            |      |      |      |      |      |  Obs |
|                            |      |      |      |      |      | erve |
+----------------------------+------+------+------+------+------+------+
| Motivation toward a        |      |      |      |      |      |      |
| successful, productive     |      |      |      |      |      |      |
| career                     |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Growth during total period |      |      |      |      |      |      |
| observed                   |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Fertility of imagination;  |      |      |      |      |      |      |
| originality of thought     |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Emotional stability and    |      |      |      |      |      |      |
| maturity                   |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Ability to work with       |      |      |      |      |      |      |
| others                     |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Mastery of fundamental     |      |      |      |      |      |      |
| knowledge in the field     |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Flexibility                |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Ability to communicate in  |      |      |      |      |      |      |
| writing                    |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Ability to communicate     |      |      |      |      |      |      |
| orally                     |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Self-reliance and          |      |      |      |      |      |      |
| independence               |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+
| Leadership potential       |      |      |      |      |      |      |
+----------------------------+------+------+------+------+------+------+

**Part 2. Descriptive Comments:** On another sheet, please add your
descriptive comments that will assist in providing a complete picture of
the applicant's character, attitudes, and ability/potential for
research. Please comment on challenges, as well as strong points.

  ----------- --------- ----------------- -------- ------- ------- ---------------
  Signature                               Date                     

  Typed or                                                 Title   
  Printed                                                          
  Name                                                             

  Phone                                   E-Mail                   

  Address                                                          

                                                                   
  ----------- --------- ----------------- -------- ------- ------- ---------------

Return to: Barbara Dorsey

> Fax: (865) 574-2846 Phone: (865) 576-9975
>
> NLM Associate Fellowship Program
>
> Science and Engineering Education, MS 36
>
> Oak Ridge Institute for Science and Education
>
> P.O. Box 117, Oak Ridge, Tennessee 37831-0117