ApplicantInformation about the Mental Health Scholars Academy applicant.Applicant Name: Degree Program: Mental Health Scholars Academy program website: EvaluationThe person named above has made application for graduate study and tuition support through the Mental Health Scholars Academy (MHSA). We would greatly appreciate your candid appraisal of the applicant.How long have you known the applicant?*In what capacity?*Note: Please be as specific as possible (e.g. professor, manager, supervisor, mentor, etc.).Please provide a rating (Outstanding, Superior, Good, Fair, Poor, Unable to judge) based on your perception of the candidate for the following characteristics:Self-Motivation*OutstandingSuperiorGoodFairPoorUnable to judgeEmotional Intelligence*OutstandingSuperiorGoodFairPoorUnable to judgeProfessionalism*OutstandingSuperiorGoodFairPoorUnable to judgeJudgment and Decision-making*OutstandingSuperiorGoodFairPoorUnable to judgeAcademic Preparedness*(e.g. writing, aptitude, timeliness, critical thinking, etc.)OutstandingSuperiorGoodFairPoorUnable to judgeTime Management and Organization Skills*OutstandingSuperiorGoodFairPoorUnable to judgeEmpathy and Concern for Others*OutstandingSuperiorGoodFairPoorUnable to judgeIn 3-4 sentences, please describe why this person is a good candidate for the Mental Health Scholars Academy (please include any special qualities, skills, academic preparedness, or qualifications that contribute to your recommendation).*What are this candidate’s strengths?*What would you consider to be the candidate's areas of growth and weakness?*What is your overall recommendation?* Strongly recommend Recommend Recommend with some reservation (please explain) Do not recommend (please explain) Please explain your overall recommendation:*RecommenderName* First Last Email Address* Recommender's Title/Position*Phone Number*Institution/Organization Name*This field is hidden when viewing the formAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Electronic Signature* I AgreeI hereby certify that the information I am submitting is complete and accurate. I understand that checking "I Agree" above acts as my signature on this form.Date* MM slash DD slash YYYY Enter today's date.PhoneThis field is for validation purposes and should be left unchanged. Δ Share This Twitter Facebook LinkedIn Email
