1. )r>
I ---
,rt tYAgp.t"fllsL.a tn in s fot Lif.
rARJ Student
Reference
Form
Mo.,^t/r. of Graduation: L.l '2)OZ
--......-....F-
Student's Name:
Program:
This Evaluatjon is Based on Course(s):
Siudent lD No:
Dates Attended MSTC: (month & y:aD: Srua(g-2J=ez ro (month & yeao: Ooal z4D3-
lnstructo/s Signature
Working Productive /Assuring Quali
An individual possesses and applies etfeclive work habits and aflitudes wilhin an
organizarional (classroom, lab, or shop) seniDs.
1. lilanages tim-- and wc* load (assignnrents, prcjects)
2. Follows salety procedures / rules
3. Handles responsibility in a dependable manner
Carries out inslruciions
Learnin Effectively
An individual possesses necessary basic skjlls in reading, wriling, and compuling;
applies skills in acquiing informalion; and uses learnins lools and stratesies.
2. Uses leahino resour.es
3. Oroani2es inlormation
Communicatin Clearly
An individual is able lo apply appropriale wrii,ng, speaking, and lislening skilis in order lo
precisely convey inlormalion, ideas, and opinions.
1. Applies the English languase correclly (spelling, glammar, struclure)
2 Speal.s underslandabiy
3 Wrilesunderslandably
I Demonsirales abillry ro lisren efleclively
5 Uses ang!age appropriale Io siiualion

2. Working Cooperativel
An r.dividual is c.p6.bi6 ol working wiih olhe.s lo compl6l6 lesks,
r^'l ^(.r s'!!4arl
i. Wo s coop€ralivsly wilh olh6rs (class.oom. shoP, precticing)
2. Oemonstrales resp€ct lor olhers through word and aclion
3- Provid€s and accopls ,66dback
An individual rocognizBs an obligation lo self and olhers lo. his or her decisions and aclions'
1. Atlends class regularly and punctually
l- Assumes responsibility lor compleling assignments
3. Performs assigned tasks
4. Works productivoly and stays on lask
Thiirkind Criiicallv and'Creative
An individual applies the princiPles and stlalegies of Ptlrpos6lol' acliv€, orga'ized lhinking'
RatinE
3 2 1 N
r ndh^hdEr.. uillihdh... t. lEddnize othars'Doinl ol ueur
i-*i^ rxo airo.ohe hetwen lrcts and ooinions l-
Commcntsi
An indivjdual uses the Plinciples ol science and recognizes the imPaci ol iechnology'
i U*;"ppr"-"t" ""t."til"
equipmenl, melhods, and salery precaulions
2- Demonslrales tech.ological literacy
Comments:
Demonstrati Globa! F-csareness
il;dilrdr.ld.r"*tt tes e,leclive inierPersonal and intergroup behavio6 in cross _ cultural
;.teractions and ellective social inleraction in a vadety o' situalions'
1. Respects cullulal ditlerences
Fnrmunicates in a cullurally sensilive Danner
Please relum comPleled folm to:
' ';;:;i;;ffi".i college career services otfice, 5oo 32nd street North' wisconsin RaPids' wl 54494
;;;;-N".b"r, (71s) 4i2-s44s or (71s) 422-s362 FAX Numb et:.Q151 422'5440
l-fr,4uif,
""*..".iri.ls@midstate.lec.vri.us.
Web page Address: wwrr.midstale.tec.wi.us
Mld-State Technical Cotlege is An Equal opportunity/Affinnative Action Educetor and Efiployer'