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CMS Faculty Reference Form

* = required field

Please enter the name of the applicant for whom you've been asked to provide a reference.

Relationship of Reference Source to Applicant

Professional Knowledge, Skills, and Attitude

Please rate the following as Excellent, Good, Average, Below average, or Unable to evaluate.

Additional Information

Summary

Please use this section for any additional comments, information, or recommendations which you believe would be relevant to our decision to grant faculty membership. If you have any questions, please contact our Coordinator, Faculty Appointments whose name and email is listed on the communication which accompanied this form.