Cytotechnology Program

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Applicant Recommendation Form

Applicant Name:*

Date:*

MM/DD/YYYY
Cytotechnology is the microscopic study of cells from body tissues to discern minute alterations and differentiate normal form abnormal cells. It is an applied science that demands diligence and attention to detail. Cytotechnologists must continually make decisions based on their interpretation of cell patterns, which can have great significance to patients. Are you familiar with the field of cytotechnology?*
    

What is your association with the applicant, and how well do you know him/her? If you instructed the applicant, briefly describe the course(s).*

Listed below are some desirable qualities of a cytotechnologist. Please rate the applicant on each item.

Sense of responsibility*
Ability to work independently (self-discipline)*
Ability to work with others (cooperation)*
Motivation (interest, commitment)*
Integrity (honesty)*
Manual dexterity*
Curiosity and imagination*
Ability to accept constructive criticism (profit from evaluation)*
Maturity (common sense, seriousness, decision-making)*
Positive attitude (ability to cope with obstacles and delays)*
Leadership potential (peer esteem)*
Written communication skills (spelling, grammar, punctuation)*
Oral communication skills (expression, questions)*
Personal appearance (grooming, appropriate attire)*
Flexibility (ability to adjust easily to new situations)*

What strengths or special qualifications does the applicant have?*

What shortcomings or limitations may affect the applicant's performance?*

If the applicant were applying for a position under your supervision, would you hire her/him?*

If desired, please provide additional pertinent information or comments regarding the applicant's abilities and potential for success in the Cytotechnology Program.*

Overall evaluation:*

Name of Evaluator*

Position*

School or Organization*

Department*

Phone*

Letter of Recommendation:
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