Summer Scrubs 2012
  
Teacher Recommendation Form

 
Complete all fields below or click here for printable version and mail your application to
Summer Scrubs, P.O. Box 2187, Mobile, AL 36652 or fax to (251) 281-2635.

Student Name:

School:

You have been selected as a reference by the above student applying to participate in the 2012 Summer Scrubs Program.  Your input is very important to us.  We are looking for students who are interested in healthcare, will attend the program each day, and are respectful of others. All responses will be kept confidential. 

Subject taught/relationship to student:

How long have you known student?

Please rate the student in the following areas:

  5
Excellent		 4
Above Average		 3
Average		 2
Fair		 1
Poor
Promptness/Attendance
Academic Achievement
Behavior
Responsibility
Eagerness to learn
Cooperation/Attitude

Do you recommend this student without hesitation to participate in Summer Scrubs?
           Yes           No

Comments:
Teacher Name: *

Phone Number:  

Email Address:  * 
                               *(required for verification purposes)
Please provide your school email address. No personal email addresses please.
RECOMMENDATION MUST BE RECEIVED NO LATER THAN MARCH 9 FOR STUDENT TO BE CONSIDERED.

                                           
 
 


Summer Scrubs is a project of the Bay Area Healthcare Coalition, a volunteer-driven organization of South Alabama healthcare providers and educators, working together to address current and projected shortages of qualified healthcare professionals in our community. s in our community.

 


The Bay Area Healthcare Coalition is an initiative of the Mobile Area Chamber of Commerce’s Center for Workforce Development