Excellence in Science, Technology, Engineering And Mathematics (ESTEAM)

Reference Form

Please print out and fill in. Print legibly or type.

1. STUDENT INFORMATION

Name of Applicant:__________________________________________________________

Reference Report on Applicant

Your name and position/title: __________________________________________________

How long have you known the applicant?__________________________________________

In what capacity?_____________________________________________________________

On the following scale, please rank the applicant among other students you've encountered:

1. Does the applicant have the academic potential and work ethic to excel in science and mathematics?
   Yes__ No__
2. Is the applicant able to tolerate guidance and/or direction from his/her cohorts?
   Yes__ No__
3. Is the applicant able to work equally well on a team or independently as the need dictates?
   Yes__ No__

2. COMMENTS

On the reverse side, please write candidly about the student's qualifications and/or potential to succeed in his/her major. Specific examples are more useful than generalizations. Please identify any concerns you may have about the student that might require the attention of the ESTEAM program staff. You may attach a separate letter if you like. Please submit your letter to arrive at the following address no later than March 1:

For New Freshmen:

Admissions Office
UW-Eau Claire
112 Schofield Hall
105 Garfield Avenue
Eau Claire, WI 54702-4004

For Currently Enrolled and Transfer Students:

ESTEAM Program
Department of Mathematics
University of Wisconsin-Eau Claire
Eau Claire WI 547020-4004