EMPA Letter of Recommendation Form

Background:

How long have you known the applicant?

Nature of contact with applicant (PA program director, instructor, mentor/advisor, colleague):

If this applicant rotated in your EM department, what was his/her grade?

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Was this the first or second EM rotation for the applicant?

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Rotation Dates?

Candidate Qualifications:

Please compare the candidate to other PA students with intention of entering EM

Commitment to emergency medicine, and careful thought about field choice:

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Ability to develop a differential diagnosis and appropriate treatment plan:

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Communication skills and intrapersonal interaction:

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Work Ethic?

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How much guidance do you think this candidate will require during residency?

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Given this amount of guidance, what do you think is the overall chance of success for the applicant?

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Global Assessment:

Compared to other PA candidates you have recommended, this applicant is considered:

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How many candidates have you referred to an EM PA residency?

What would you like us to know about the candidate? (feel free to continue on a word document and upload it as an attachment)

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