The University Hospital of Arkansas

Name of Student: __________________________________________________

School: __________________________________________________________

Date of Graduation: _________________________________________________

I,________________________________ give my permission for
(student)

__________________________________
(faculty)

to complete the following faculty reference:

Rank each descriptor by placing an “ X” in the selected box.

	Below Average	Average	Above Average	Superior
Initiative
Quality of Work
Dependability
Communication
Ability to Work Independently
Ability to Work With Others

Additional comments/concerns:

_________________________________________________________
Signature of Faculty Date

1/01