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**Student Reference Report Form**

  ---------------- -------------------- ---------------------- ------------------
  **Applicant:**                                                    

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

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

Compared to other students you have known in the last five years, of
comparable age and experience, how would you rate the applicant with
respect to the following **PERSONAL CHARACTERISTICS**?

  ---------------------------- ----------- ------------- ---------- -------- ----------------- -------------
                               **Below     **Average**   **Good**   **Very   **Exceptional**   **No basis
                               Average**                            Good**                     for
                                                                                               Judgement**

  Motivation and persistence                                                                   
  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                                                                         

  Demonstration through words                                                                  
  and deeds of benefiting                                                                      
  society through their work                                                                   
  in science and technology                                                                    
  and their dissemination of                                                                   
  science and technology                                                                       
  ---------------------------- ----------- ------------- ---------- -------- ----------------- -------------

Compared to other students you have known in the last five years, of
comparable age and experience, how would you rate the applicant with
respect to the following **SCIENTIFIC CAPABILITIES**?

  --------------------------- ----------- ------------- ---------- -------- ----------------- -------------
                              **Below     **Average**   **Good**   **Very   **Exceptional**   **No basis
                              Average**                            Good**                     for
                                                                                              Judgement**

  Mastery of fundamental                                                                      
  knowledge in their field                                                                    

  Skill/originality of                                                                        
  research project design                                                                     

  Laboratory skill and                                                                        
  technique                                                                                   

  Productivity in research                                                                    

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

  ---------------- -------------------- ---------------------- ------------------
  **Applicant:**                                                    

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

Add any descriptive comments that will assist in providing a complete
picture of the applicant's abilities. Include specifics about this
applicant that will demonstrate why this applicant will be persistent
and productive doing research.

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  **COMMENTS:**                           

  Name:                                   

  Date:                                   Title:     

  Department:                             Institution/Organization:     

  Telephone:                              E-Mail:     
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*Submit electronically by **February 3, 2009** or send via postal mail
with a postmark deadline of **February 3, 2009**.*

**Send all electronic materials to:**

[**dhsed@orau.org**](mailto:dhsed@orau.org)

**Send all postal materials to:**

Oak Ridge Institute for Science and Education

DHS Summer Research Team Program, MS-36

P.O. Box 117\
Oak Ridge, TN  37831-0117