Student Exchange Reference Check Form
Please provide your candid and thorough evaluation of the student applying for the exchange program. Your responses will remain confidential and are crucial for the selection process.
Student's Full Name
*
First Name
Last Name
Reference Provider's Full Name
*
First Name
Last Name
Reference Provider's Email Address
*
example@example.com
Reference Provider's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Position/Title
*
Institution/Organization
*
How long have you known the student?
*
Please Select
Less than 6 months
6 months to 1 year
1-2 years
More than 2 years
In what capacity do you know the student?
*
Teacher/Professor
Academic Advisor
Employer/Supervisor
Other
Please rate the student in the following areas:
*
Rows
Excellent
Good
Average
Below Average
No Basis
Academic Performance
1
2
3
4
5
Communication Skills
6
7
8
9
10
Initiative
11
12
13
14
15
Adaptability
16
17
18
19
20
Teamwork
21
22
23
24
25
Leadership
26
27
28
29
30
Responsibility
31
32
33
34
35
Integrity
36
37
38
39
40
What do you consider to be the student's greatest strengths?
*
What areas could the student improve upon?
Please provide any additional comments regarding the student's suitability for the student exchange program.
Do you recommend this student for participation in the exchange program?
*
Yes, strongly recommend
Recommend
Recommend with reservations
Do not recommend
Date of Completion
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature (Please sign below to confirm your reference)
*
Submit Reference
Submit Reference
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