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

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3

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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.*

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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.*

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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.
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Reference Signature

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Reference Form

Applicant Evaluation