GSI Student Program, Aug. 02 - Sep. 24, 2010

CONFIDENTIAL REPORT ON CANDIDATE

Family name:...................................

First name :......................         Date of Birth:..................  

The student named above is applying for the GSI Student Program. The program is offered to students in physics or related natural science disciplines who will have completed their third year of university study by next summer. We would like to ask your assistance in assessing his/her ability by completing this form. Please return it in a sealed envelope to the candidate or sent it directly to the address given below (e.g. by FAX), to arrive before January 31.

I have known the student for ........... months/years from his/her participation in: lectures (...) seminars (...) laboratory courses/exercises (...) examinations (...). Please judge also her/his ability to communicate in English.
I wish to report on him/her as follows:

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I would place him/her in the following category compared to other students of same semester at our university:

	exceptional	...very good...	.....good.....	..average..	below average
	(best 5%)	(best 10%)	(best 25%)	.	.
academic ability	.	.	.	.	.
practical ability	.	.	.	.	.
originality	.	.	.	.	.
critical judgment	.	.	.	.	.
communication in English	.	.	.	.	.

Name and address/ institution of referee

............................................   Stamp of the Faculty/ Institution

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Phone:       ...............................

Fax:         ...............................   Signature: .....................

E-mail:      ...............................   Date:      .....................