Name of applicant *
Name of referee *
Position *
Email *
Unit/Department *
Are you the direct supervisor of the applicant? *
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Contribution to UHN rating *
- Select - 1 - lowest 2 3 4 5 - highest
Contribution to unit/department rating *
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Quality of interdisciplinary collaboration with colleagues *
- Select - 1 - lowest 2 3 4 5 - highest
Excellence in collaborative, competent, compassionate pcc *
- Select - 1 - lowest 2 3 4 5 - highest
Excellence in preceptorship & mentorship rating *
- Select - 1 - lowest 2 3 4 5 - highest
True leadership, initiative and courage of conviction rating *
- Select - 1 - lowest 2 3 4 5 - highest
How strongly do you support this individuals application *
- Select - 1 - lowest 2 3 4 5 6 7 8 9 10 - highest