Reference Form for Study Abroad Applicant

Reference Form

C-N Adventurers Study Abroad Program
Applicant's Name

First NameLast Name
Reference's Name

First NameLast Name
Email Address
example@example.com
Relationship to the Applicant
Applicant Evaluation

On a scale of 1 (Strongly Disagree) to 5 (Strongly Agree), please rate your level of agreement for the following statements: The applicant...
Is respectful of authority figures.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Promptly follows directions.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Accurately follows directions.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Takes responsibility for his/her actions.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is respectful of his/her peers.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Accepts other people's opinions and preferences, even when they differ from the applicant's.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Collaborates well with others.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Effectively manages stressful situations.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is organized.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is adaptable.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is reliable.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is trustworthy.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is compassionate.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Is passionate about study abroad.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Please provide any additional comments you would like to share about the applicant.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reference Signature
Should be Empty:

Reference Form

Applicant Evaluation