MID-EASTERN SYMPOSIUM ON THERAPEUTIC RECREATION
FACULTY EVALUATION OF STUDENT APPLICANT

To be completed by a faculty member in the student’s department and sent directly to the Chair of the Student Scholarship at:

Val Dickerson, CTRS
50 Pleasant Way,
Montclair, NJ 07042
Phone: (212) 539-6423
FAX: (212) 477-3121
Email: valstan50@yahoo.com

Applicant’s Name:________________________________________________________

College/University:________________________________________________________

Department/Program:______________________________________________________

As of the spring semester of the current academic year, this student is a:

[ ] graduate student or [ ] undergraduate student

Please write an evaluation of how the applicant would benefit from participating in the Mid-Eastern Symposium on Therapeutic Recreation and their potential to meaningfully interpret their experience to others.

How would you rank this student’s performance in comparison with other students at the same level of study? Please rank the applicant from 1 to 5, with 5 being the highest.

Rank:__________

This evaluation prepared by:

Signature:

Print Name:

Date:

Phone: