Evaluation for Graduate Admission

Please read instructions carefully before you complete this form.

Part 1

To be completed by

all applicants

Please type or print using black ink.

If you are mailing this evaluation separately from your application, send directly to: MLOG Admissions Office, 77 Massachusetts
Avenue, Room E40-355, Cambridge, MA 02139
Name: ________________________________________________________________________________________________________
last/family

first

middle

Applying for admission in the department of___________________________________________________________________________

For the ultimate degree of___________________________________________area of research__________________________________
For the term beginning in

September_________

email________________________________________

year

Under the Family Educational Rights and Privacy Act of 1974, a student enrolled at MIT has access to his or her education records. We
intend to comply with both the letter and the spirit of this law, while still allowing the student the option of waiving the right to access. If
you wish to waive the right to examine this evaluation at a later date, please sign here.
Applicants signature____________________________________________________________________________________________________________________________________________
Part 2

To be completed by

evaluator

An application for admission to MIT requires evaluations from three people capable of judging the professional and academic promise of
the applicant. MLOG applicants are encouraged to provide two evaluations from professional sources (i.e., supervisors) and one from an
academic source (i.e., professor). A separate letter of evaluation may be attached to this form if necessary.
Please return in time for him/her to meet the following deadlines: January 11 for Round One MLOG applicants or April 3 for Round Two
MLOG applicants.
Please seal and sign the envelope
Evaluators name: __________________________________________ Title _______________________________________________
Address ______________________________________________________________________________________________________
School or company __________________________________________Telephone number ____________________________________
email _________________________________________________________________________________________________________
How long, and in what capacity have you known the applicant? ___________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
How does this applicant compare with his or her peer group in academic ability?

Truly exceptional Outstanding Well above average Above average Average Below average Inadequate opportunity
equivalent to the very best
you have known - a person
who, in your experience,
appears only every few years

comparable to the
best student in a
class

top 20%

demonstrated high
ability

able to complete
lower 50%
graduate coursework

to observe

How does this applicant compare with his or her colleagues in their managerial and/or technical leadership ability?

Truly exceptional Outstanding Well above average Above average Average Below average Inadequate opportunity
equivalent to the very best
you have known - a person
who, in your experience,
appears only every few years

comparable to the
best colleague in a
department

top 20%

demonstrated high
ability

demonstrated

lower 50%

to observe

If applicable, please give the applicants relative standing in your class or department (e.g., 7th in 89) _____________________________
(continue

on reverse side)

MLOG Evaluation Form Rev. 08-2009

Provide an example of the candidates managerial and/or technical leadership abilities, and how he/she used these skills to affect change
in an organization, company or group?
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

Provide an example that illustrates the candidates strongest traits.

______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

In what ways could the applicant improve professionally?

______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

Is there anything else we should know about the candidate?

______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

MLOG Evaluation Form Rev. 08-2009

If the applicants first language is not English, please evaluate her/his proficiency to read, write, and speak English.__________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

Evaluators signature ________________________________________________________ Date ________________________________

Please feel free to add information about your own educational and professional background if you feel that such information will
enhance our understanding of your evaluation.
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________

Please seal and sign the envelope before returning to applicant.

MLOG Evaluation Form Rev. 08-2009