3 form

U.S. Department of Health and Human Services
Public Health Service - National Institutes of Health

Pharmacology Research Associate Program
Request for Evaluation of Applicant
Dear Evaluator:
Your recommendation is sought for an applicant to the Pharmacology Research Associate Program of the National
Institute of General Medical Sciences. In selecting candidates, reviewers depend greatly upon advice from people
who have been associated with the applicant. Therefore, we are asking you to provide information on the enclosed
form (NIH 2721-2). Individuals selected for this highly competitive program should have both meritorious scientific
qualifications and outstanding personal character. Your frank evaluation will be valuable in determining the
applicant's suitability for this program.
It is strongly encouraged to provide an additional letter. More detailed information on the applicant can be extremely
helpful in the selection process. Under the provisions of the Privacy Act, the information you provide may be
disclosed to the applicant upon request. If there is significant information which you feel you cannot provide without
a pledge of confidentiality, please feel free to contact either one of us by telephone at (301) 594-3583.
We must receive the mailed materials by December 18, 2009. Please send to:
PRAT Program Assistant
NIGMS, NIH
Room 2AS-43D
45 Center Drive, MSC 6200
Bethesda, MD, 20892-6200
Alternatively, you may transmit this to us by email as an attached file to [email protected]
or by Fax at (301) 480-2802.
Sincerely yours,
Pamela A. Marino, Ph.D.
PRAT Program Co-Director

Richard T. Okita, Ph.D.
PRAT Program Co-Director

OMB No. 0925-0378
Form approved through 12/31/10
U.S. Department of Health and Human Services
Public Health Service - National Institutes of Health

Pharmacology Research Associate Program
Request for Evaluation of Applicant
Name of Applicant

Instructions:
This form MUST be received by COB December 18, 2009.
This form is NOT CONFIDENTIAL.
Additional information, in the form of a letter, would be helpful.

Last:
MI:

1. What is your estimation of the candidate's motivation and potential
for research?
Best you've ever seen

Among the upper third

Among the top few

Average

Among the top 5-10%

Below Average

First:

Comments:

2. How apt a scholar is the applicant? Consider such things as class Comments:
standing, grades, scholarship honors, special honors, special training
or any other factors known to you which you deem pertinent.
Best you've ever seen

Among the upper third

Among the top few

Average

Among the top 5-10%

Below Average

Comments:
Class standing, if known to you:
Do you think the applicant's class standing accurately reflects
scholastic abilities in the disciplines particularly pertinent to biological
research?
Yes
No
N/A

3. Please grade the candidate with respect to the qualities set forth in the table below.
Quality

No Basis for
Judgment

Best you've
ever seen

Top Few

Upper 10%

Upper Third

Average

Below Average

a. Initiative
b. Sustained hard work
c. Rapport with preceptors
d. Rapport with co-workers

Public reporting burden for this collection of information is estimated to average 105 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974., ATTN: PRA (0925-0378). Do not return the completed form to this
address.

NIH 2721-2 (8/04) Front

4. What are the main strengths and assets which this applicant possesses?

5. What are the defects or weaknesses which in your judgment might limit applicant's effectiveness?

6. How long have you known this applicant?

7. Recommendation:

Highly

Qualified and Competent

Name of Evaluator

Position

University, Medical School or Hospital (name and mailing address)

Office Phone No.

Reservation

Evaluator's Signature

Not Recommended

Date

Public reporting burden for this collection of information is estimated to average 105 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: NIH, Project
Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974., ATTN: PRA (0925-0378). Do not return the completed form to this
address.

NIH 2721-2 (8/04) Back