<p> COMMITTEE ON ADMISSIONS AND ACADEMIC STANDING Stanley S. Bergen Medal of Excellence Evaluation Year: ______</p><p>Name of Candidate: ______</p><p>Program: ______</p><p>Recommended by: ______</p><p>Program level: _____Associate _____Bachelors ______Graduate</p><p>Academic Award ______Clinical Award ______Student Excellence in Service Award ______GPA (minimum 3.5) ______</p><p>In all categories the student shall exhibit performance beyond that which is expected by the program. More than one category can be selected if appropriate (example leadership in program directed activities and evidence of leadership in self directed activities) </p><p>1. Clinical Excellence: Consistent outstanding performance.</p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>2. Leadership: Elected positions within and outside SHRP. Demonstrated leadership role. </p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5 3. Scholarly Activity: Research, clinical projects, reports, presentations (example SHRP poster day, or professional association poster presentation).</p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>4. Community Service: Include volunteer or community service activities in any area. </p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>5. Professional Involvement: Membership in professional association, involvement in professional activities or related activities.</p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>6. Service to the University: Participation in school or university committees, task forces and related activities.</p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>7. Special Projects</p><p>No evidence of involvement beyond what is required by the program _____0 Meets “high end” program expectations ______1 Outstanding performance noted ______3 Evidence of Exceptional performance ______5</p><p>Supporting documentation:</p><p>Note: Recipient will be notified by the Dean. The selection committee will notify the individual(s) who made the recommendation.</p><p>Rev 5/2010</p>