Name:
Please independently assess each of the following as:
(5=Outstanding, 4=Good, 3=Average, 2= Borderline, 1=Reject)
1. Intellectual Ability
2. Evidence of Commitment and Interest (including work
experience) and Awareness of the Realities of Medicine
3. Evidence of Teamwork and Leadership Skills
4. Communication Skills and Empathic Traits
5. Overall Global Score
COMMENTS
Please add comments summarising this applicant performance, your general impressions, and anything else you
feel is important. This section must be completed for any area you score 2-1.
Signed …………………………………. Date …………………………….