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Chicago Medical School

CMS Faculty Reference Form

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Reference

Please enter the name of the applicant for whom you've been asked to provide a reference.

Relationship of Reference Source to Applicant

Do you personally know the applicant? *

Professional Knowledge, Skills, and Attitude

Please rate the following as Excellent, Good, Average, Below average, or Unable to evaluate.

Medical/Clinical Knowledge *
Communication skills with peers, staff, trainees *
Educational Skills (Classroom, Ambulatory, and/or Bedside Teaching) involving trainees *
Professionalism *

Summary

My general recommendation concerning this applicant is: *

Comments

Please use this section for any additional comments, information, or recommendations which you believe would be relevant to our decision to grant faculty membership. If you have any questions, please contact our Coordinator, Faculty Appointments whose name and email is listed on the communication which accompanied this form.

Name of person completing this reference form (Typing your name below will count as your signature) *