Application Part 3_Recommendation_AIedits

NIFA Veterinary Medicine
Loan Repayment Program (VMLRP)

National Institute of Food and Agriculture
US Department of Agriculture
OMB No. 0524-0050
Form Approved For Use Through XX/XX/XXXX

APPLICATION PART 3: RECOMMENDATION
NIFA Veterinary Medicine Loan Repayment Program
Instructions: Complete the sections below. Email this form to [email protected] or fax to (833) 2088205 according to the instructions detailed in the Request for Application prior to the deadline. For additional
information, visit the VMLRP website (https://www.nifa.usda.gov/grants/programs/veterinary-medicine-loanrepayment-program/vmlrp-general-information).
Handwritten responses will not be accepted. Retain a copy in the event delivery failure requires resubmission
of this form.
Section 1. Recommender Information
Recommender’s Name:

First Name

Middle Name

Last Name

Suffix

State

Zip Code+4

Relationship to Applicant:
Position/Title:
Organization/Business:
Work Address:

Street

City

Telephone Number:

(Area code required)

Email Address:
Section 2. Applicant Information
Applicant’s Name:

First Name

Middle Name

Last Name

Suffix

How long have you known
the applicant?
(include approximate dates)

(Please limit your response to 50 characters)

1
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.

Section 3. Recommendation
Instructions: All fields on this form are required. You may elect to cut and paste text from another document
into the text fields. If you have no further information to add to a question, please indicate “No Comment” or
“N/A”.
Select the rating that best indicates your assessment of the applicant in relation to his/her peers.
Rating of Applicant
Previous training and experience to serve in the veterinary shortage
situation applied for
Career goals and plans to achieve these goals

Outstanding
1
2

3

Average

4

Poor
5

Don’t
Know

Commitment to providing veterinary services similar to those needed to
fill this shortage
If applicable, potential for success operating a single-practitioner
veterinary practice
Civic mindedness
Interpersonal skills
Critical thinking/Problem solving skills
Overall assessment of applicant

Short Answers: Please limit your response to 700 words for each question. Utilize this form to complete each
response. Attachments will not be accepted.
1. Describe your assessment from the ratings indicated of the applicant above?

2. What are the main strengths and weaknesses that the applicant brings to his/her work environment?

2
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.

3. What is your assessment of the applicant’s practice plans and logistics relative to the specific shortage
situation he/she is applying for?

4. What is your overall recommendation for the applicant?

Section 4. Certification of Recommendation
I certify that the statements herein are true, accurate, and complete.

Signature of Recommender (certified electronic or scanned ink)

Date

Public reporting for collection of information is estimated to average 60 minutes, 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 current 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 NIFA, OGFM, 2312 East Bannister Road, Mail Stop 10,000, Kansas City, MO 64131, Attention
Policy Section. Do not return the completed form to this address.

OMB No. 0524-0050
3
NIFA invests in and advances agricultural research, education, and extension and promotes transformative discoveries that solve societal challenges.
USDA is an equal opportunity lender, provider and employer.