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Sentara RMH School of Radiologic Technology Reference Form
Student first name
Student last name
NOTE: Federal regulations require that the applicant may have access to this information.
Scholarship: Mastery of academic and professional subject.
Excellent
Above average
Average
Below average
Poor
N/A
Personal Appearance: Dress, cleanliness, and overall appearance.
Excellent
Above average
Average
Below average
Poor
N/A
Cooperativeness: Ability to work under direction.
Excellent
Above average
Average
Below average
Poor
N/A
Responsibility: Ability to accept assignments and follow through.
Excellent
Above average
Average
Below average
Poor
N/A
Emotional Stability: Ability to react under stress in a mature and dependable manner.
Excellent
Above average
Average
Below average
Poor
N/A
Communication: Ability to express self.
Excellent
Above average
Average
Below average
Poor
N/A
Integrity: Adherence to honesty in dealing with others.
Excellent
Above average
Average
Below average
Poor
N/A
Professional/Job Skills: Ability to learn and perform tasks related to occupation.
Excellent
Above average
Average
Below average
Poor
N/A
Dependability: Ability to meet deadlines, attendance requirements, etc.
Excellent
Above average
Average
Below average
Poor
N/A
Professional Potential: In your opinion, potential for success as a health care professional with direct patient contact.
Excellent
Above average
Average
Below average
Poor
N/A
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