Housestaff Applicant Evaluation Form

* Indicates required field

* Applicant Last Name:
* Applicant First Name:
* Medical School:
* Interview Date: (mm/dd/yyyy)
* Interview Time: (military time no colon)
* Interviewer:
* Interviewer Email Address:

6=Highest possible. 5=Upper 10% of applicants. 4=Upper 25% of applicants. 3=Upper half of applicants.
2=Lower half of applicants. 1=Just acceptable.  0=Not Reviewed.

* Deans Letter 6 5 4 3 2 1 0
* Letters of Rec 6 5 4 3 2 1 0
* Grades/Scores 6 5 4 3 2 1 0
* Interview 6 5 4 3 2 1 0
Comments:
(if no comment type 'None')
Please use the 'Enter' key at the end of each line when entering comments.
* Overall Assessment: (choose only one)
Highest possible; Should be ranked in the top 5% of all applicants
Upper 10% of class; AOA; Distinguished; Should be ranked in the top 15% of all applicants
Upper 25% of applicants
Upper half of applicants
Lower half of applicants
Just acceptable
Not acceptable; Better to go unmatched and "scramble"
YES
NO
* Please check 'YES' or 'NO' if you are planning to attend the next Applicant Selection Committee Meeting at Noon on Thursday in the Department of Medicine Conference Room.
The information submitted here is confidential. Please contact Susan Major at 5-0239 with questions.

If you experience any problems with this form contact Jim Horne @ 265-7211