The UAMS Medical Center

Externship Program

Faculty Reference

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

*Faculty: Please fax to Nurse Business Office: 501-686-6091

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