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					                       SDSU / UCSD / UM-DULUTH MIRT Faculty Recommendation Form
                                                         Last Updated: 09/25/2011

                                            MIRT
       MINORITY INTERNATIONAL RESEARCH TRAINING PROGRAM
                SDSU/UCSD/UM-DULUTH CONSORTIUM

  Sponsored by: The National Center for Minority Health and Health Disparities (NCMHD)

MIRT is an international research experience that prepares students for a career in
   biomedical research. The long-term objective is to increase the number of
            underrepresented minority faculty in biomedical science.

                         FACULTY RECOMMENDATION FORM

DEAR FACULTY MEMBER:

We would appreciate your candid evaluation of the student listed below who is applying for the
NIH/NCMHD Minority International Research Training award. Your comments will be held
confidential. Your prompt response will be appreciated since incomplete applications will not be
evaluated. Please confine your evaluation to this form, which can be completed online by clicking
in a box and typing. Thank you in advance for your time and cooperation. (FAX OR MAIL THE
COMPLETE FORM TO THE CONTACT BELOW; PLEASE DO NOT RETURN THE FORM TO THE
STUDENT.)

    1. Student’s name:
    2. Faculty member:
    3. Institution

        Address

        State          Zip Code       Telephone (        )

    4. Approximately how long have you known this applicant?

    5. How well are you acquainted with the applicant as a person? Please select one _

    6. How well are you acquainted with the quality of his or her work? _

    7. In which course(s) have you had the applicant as a student?

    8. Is the student currently in your lab? Yes       No

    9. If so, will he or she return to your lab after the international research experience?

        Yes       No      N/A

    10. Please rate the student by selecting the appropriate areas below:

                                   General Intelligence Unknown
                                      Academic Ability Unknown



                                                   1
                  SDSU / UCSD / UM-DULUTH MIRT Faculty Recommendation Form
                                                    Last Updated: 09/25/2011
                    Ability to Integrate Information Unknown
                          Ability for Understanding Unknown
                                           Creativity Unknown
                                              Interest Unknown
                                        Perseverance Unknown
                             Laboratory Techniques Unknown
                                 Social Adaptability Unknown

   11. Why do you feel that this applicant would benefit from the MIRT program? (THE
       PURPOSE OF THE MIRT PROGRAM IS TO BROADEN CULTURAL
       PERSPECTIVES AND ENCOURAGE GIFTED MINORITY STUDENTS TO
       CONSIDER A RESEARCH CAREER IN THE BIOMEDICAL/BEHAVIORAL
       SCIENCES BY ENTERING A DOCTORAL DEGREE-GRANTING PROGRAM. THE
       LONG-TERM GOAL OF MIRT IS TO INCREASE MINORITY FACULTY
       REPRESENTATION IN THE BIOMEDICAL SCIENCES.)



   12. To your knowledge, are there any special circumstances—financial, social, or
       otherwise—which you believe require consideration?




Signature_____________________________________ Date__________________

ON BEHALF OF THE MIRT DIRECTORS, THANK YOU FOR TAKING THE TIME TO COMPLETE THIS
RECOMMENDATION. PLEASE SEND THIS INFORMATION BY FAX (619-594-3484) OR MAIL TO THE
CONTACT BELOW. THANK YOU.

                                     DR. R. S. POZOS
                                     MIRT DIRECTOR
                                  COLLEGE OF SCIENCES
                               SAN DIEGO STATE UNIVERSITY
                                 5500 CAMPANILE DRIVE
                                SAN DIEGO, CA 92182-4616

                                  PHONE: (619) 594-2581
                                   FAX: (619) 594-3484
                                 bpozos@sciences.sdsu.edu




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