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    Form 5 Santi Wilujeng

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    Santi Wilujeng
    This document is an application form for The Hansen Summer Institute on Leadership and International Cooperation. It requests an academic advisor reference for the applicant. The advisor is asked to evaluate the applicant's character traits such as maturity, leadership, and honesty. They are also asked how long they have known the applicant, in what context, and the applicant's English proficiency. The advisor must submit this completed form along with a one page letter of recommendation for the applicant.

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    Form 5 Santi Wilujeng

    Uploaded by

    Santi Wilujeng
    55 views1 page
    This document is an application form for The Hansen Summer Institute on Leadership and International Cooperation. It requests an academic advisor reference for the applicant. The advisor is asked to evaluate the applicant's character traits such as maturity, leadership, and honesty. They are also asked how long they have known the applicant, in what context, and the applicant's English proficiency. The advisor must submit this completed form along with a one page letter of recommendation for the applicant.

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    This document is an application form for The Hansen Summer Institute on Leadership and International Cooperation. It requests an academic advisor reference for the applicant. The advisor is asked to evaluate the applicant's character traits such as maturity, leadership, and honesty. They are also asked how long they have known the applicant, in what context, and the applicant's English proficiency. The advisor must submit this completed form along with a one page letter of recommendation for the applicant.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    55 views1 page

    Form 5 Santi Wilujeng

    Uploaded by

    Santi Wilujeng
    This document is an application form for The Hansen Summer Institute on Leadership and International Cooperation. It requests an academic advisor reference for the applicant. The advisor is asked to evaluate the applicant's character traits such as maturity, leadership, and honesty. They are also asked how long they have known the applicant, in what context, and the applicant's English proficiency. The advisor must submit this completed form along with a one page letter of recommendation for the applicant.

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    © All Rights Reserved
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    You are on page 1of 1

    2015

    THE HANSEN SUMMER INSTITUTE ON LEADERSHIP AND INTERNATIONAL COOPERATION


    Applicant Name _____________________________________________

    FORM 5. REFERENCE FROM AN ACADEMIC ADVISOR


    INSTRUCTIONS
    To Applicant: Please ask one of your
    academic advisors, who knows you
    well, to complete this form. Complete
    the information on the top of this form
    then save it; email a saved copy of the
    form to the person you ask.
    This Form MUST be submitted with
    an Evaluative Statment from your

    NAME OF REFEREE

    ___________________________

    Last Name

    First Name _______________

    ____________________________________________
    POSITION OF REFEREE
    ________________________________________________________________
    ADDRESS
    ______________________
    CITY

    __________________________
    STATE OR PROVINCE

    __________________
    POSTAL CODE

    _________________________________________
    TELEPHONE: AREA CODE/ NUMBER

    referee.

    _________________________________________
    EMAIL ADDRESS

    To the Referee: Please fill in the

    5.1 Please evaluate the candidates character in the following categories (choose one option,
    excellent, good, fair or poor, from the drop down list)

    requested information. Your answers


    on this form will be evaluated along
    with the candidates own application

    Personality Traits:
    Maturity

    Excellent

    Good

    Fair

    Poor

    materials to determine his/her

    Openness

    Excellent

    Good

    Fair

    Poor

    Sense of Humor

    Excellent

    Good

    Fair

    Poor

    Leadership

    Excellent

    Good

    Fair

    Poor

    Ability to interact with others Excellent

    Good

    Fair

    Poor

    Honesty

    Excellent

    Good

    Fair

    Poor

    one page evaluative statement on

    Responsibility

    Excellent

    Good

    Fair

    Poor

    University letterhead and submit it with

    Respect for others

    Excellent

    Good

    Fair

    Poor

    Motivation

    Excellent

    Good

    Fair

    Poor

    Curiosity

    Excellent

    Good

    Fair

    Poor

    suitability for this program. Therefore


    we ask you to answer each part
    honestly, carefully and completely. This
    form must be filled out in English
    Evaluative Statement: Please write a

    this form. Include reference to


    strengths and weaknesses of the
    candidate, seriousness of purpose, and
    your estimation of the candidates

    __________________________________________________________________________

    academic performance and leadership

    COMMENTS

    potential.

    5.2

    How long have you known this candidate? Years: ____________

    Submit this form and the evaluative


    statement via mail, email or fax to:

    5.3

    In what context have you known this candidate? _____________________________

    5.4

    What is this candidates proficiency in English?

    EMAIL: blamb@sandiego.edu
    MAIL: The Hansen Summer Institute
    on Leadership and International
    Cooperation
    University of San Diego
    School of Leadership and Education
    Sciences
    5998 Alcala Park
    San Diego, California 92110-2492
    FAX: 619-849-8195

    Reading

    Excellent

    Good

    Fair

    Poor

    Writing

    Excellent

    Good

    Fair

    Poor

    Listening

    Excellent

    Good

    Fair

    Poor

    Speaking

    Excellent

    Good

    Fair

    Poor

    By submitting this form to the Hansen Summer Institute, I certify that this candidate
    speaks English fluently.
    Would you be willing to sit in on a telephone interview with this candidate? ___________
    CURRENT ACADEMIC LEVEL OR YEAR

    ___________

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