Grambling State University
P.O. Box 569
Grambling, Louisiana 71245
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Complete the information below.

*Student Name:           
                                                       Last                                                        First                                                 Middle
Address:         Tel#:
   City                              State                     Zip


This student is applying to the MARC U STAR program at GSU. The program is highly competitive and considers only high caliber junior and senior students who are seriously planning on pursuing graduate study (Ph.D. or M.D./Ph.D.) in biomedical sciences. The program offers generous financial support which includes tuition and $969 stipend for up to 24 months, and an opportunity to participate in summer research internships at research intensive institutions during the summer months.

Your candid evaluation would be very helpful to us in choosing highly qualified candidates. We are primarily interested in whatever you think is important about the applicant�s academic and personal qualification for this prestigious scholarship. After completing the rating form including the letter of recommendation on the last page of this form, please submit online using the �SUBMIT TAB�.


  1.  *I have known the applicant for a period of in the capacity of

  2.  *The applicant ranks academically with other students taught in recent years as follows:
 Top 5%          Top 10%          Top 25%          Average          Below Average

  3.  *Major strengths of this student as a prospective participant in the MARC U STAR program are:


  4.  *Major weaknesses of this student as a prospective participant in the MARC U STAR program are:


  5.  *The applicant in relation to perceived ability to successively pursue graduate or professional health program (Ph.D. or M.D/Ph.D.) is rated as follows:

Excellent Good Below Average No Observation
Very Good Average Poor  


  6.  *Please rank the applicant on the following traits, in comparison with other students you have taught.
TRAIT One of the few encountered in my career Excellent Very Good Good Average Below Average No support to observe
 1.  Intellectual Ability
 2.  Creative, original thought
 3.  Academic Achievement
 4.  Independence, initiative
 5.  Ability to communicate with
 6.  Emotional stability
 7.  Attendance
 8.  Effective class discussion
 9.  Disciplined work habits
 10. Comprehension
 11. Accuracy/attention to
 12. Sense of Responsibility
 13. Cooperative Attitude
 14. Self confidence
 15. Potential for growth


  7. What are the first word(s) that comes to mind to describe this student:

  8.  *The applicant is recommended:
Enthusiastically Recommended with reservation
With Confidence Not recommended
Recommended No basis for recommendation

  9. Please insert your Letter of Recommendation in this space:


  10.  *Name:  Title:



Telephone: ()


Fax: ()

*Name/Signature:   E-Sign    Date:

Thank you for your efforts.  We are grateful for your assistance in selecting deserving MARC candidates.

* = Required