Texas College of Osteopathic Medicine Graduate Certificate in Academic Medicine (GCAM) TCOM Education Conclave Chief Resident Leadership Skills Conference Texas FM Leadership Conference TCOM Academy of Medical Educators in GME On-Demand Workshops Vision and Mission Meet the Team Contact Us Faculty Development Center Home TCOM Home HomeTexas College of Osteopathic MedicineFaculty Development CenterGraduate Certificate in Academic Medicine (GCAM)Graduate Certificate in Academic Medicine Menu Graduate Certificate in Academic Medicine (GCAM) TCOM Education Conclave Chief Resident Leadership Skills Conference Texas FM Leadership Conference TCOM Academy of Medical Educators in GME On-Demand Workshops Vision and Mission Meet the Team Contact Us Faculty Development Center Home TCOM Home Graduate Certificate in Academic Medicine GCAM Reference form RECOMMENDER: This form is considered part of the student's application materials and is required before action can be taken with regard to the student’s applicant status. Any information you provide is protected by the 1974 Family Educational Rights and Privacy Act (FERPA). These recommendations must address the applicant’s abilities engaging in analytical and critical thinking, writing at a graduate level, and using technology to complete course-related projects. Applicant’s Name:Applicant’s Name: Recommender’s Name:Recommender’s Name: Recommender’s Title:Recommender’s Title: Recommender’s Signature: (print name) Date: 1. I have known the applicant for, years months 2. I know the applicant: Not at all Slightly Fairly well Very well 3. I have known the applicant (check all that apply):In an educational setting: Graduate student/medical student Resident Advisee Other In a work setting:In a work setting: Colleague Employee Supervisor Other 4. Compared to other health professionals of like training, rate this applicant on each characteristic: Emotional maturity Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Ability to work with others Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Leadership skills/qualities Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Flexibility and adaptability Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Intellectual curiosity Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Writing ability Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Speaking ability Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Problem-solving ability Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment Professional commitment Upper 5% Upper 10% Upper 25% Upper 50% Lower 50% No basis for Judgment 5. Recommendation (check one): I recommend the applicant without reservation. I recommend the applicant with reservation (please explain in Item 6) I do not recommend the applicant. 6. In the space provided below, please describe (a) how well you know the applicant and in what capacity and (b) how you would compare the applicant in intellectual ability, motivation, work habits and academic promise to other health professionals. Please comment on the candidate’s strongest/weakest characteristics and any other information you consider relevant.For more information, please contact the Faculty Development Center at fdc@unthsc.eduNameThis field is for validation purposes and should be left unchanged. Questions? email us at fdc@unthsc.edu
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