2015 THE HANSEN SUMMER INSTITUTE ON LEADERSHIP AND INTERNATIONAL COOPERATION

Applicant Name _____________________________________

FORM 6. REFERENCE FROM A NON GOVERNMENTAL

ORGANIZATION (NGO)
NAME OF REFEREE
LAST NAME ___________________________ FIRST NAME ____________________
INSTRUCTIONS _____________________________________________________
POSITION OF REFEREE
To Applicant: Complete the information on
_______________________________________________________________
the top of this form. Please ask a reference ADDRESS
from a community organization or NGO,
_________________________ ______________________ ______________
that knows you well, to complete this form. CITY STATE OR PROVINCE POSTAL CODE
Email this form to the person you ask.
________________________________________
TELEPHONE: AREA CODE/ NUMBER
To the Referee: Please fill in the
________________________________________
information below and sign this document. EMAIL ADDRESS
Your answers on this form will be evaluated
6.1 Please evaluate the candidate’s character in the following categories
along with the candidate’s own application
(choose one option: excellent, good, fair or poor)
materials to determine his/her suitability for Personality Traits:
this program. Therefore we ask you to Poor
Maturity Excellent Good Fair
answer each part honestly, carefully and
Openness Excellent Good Fair Poor
completely. This form must be filled out in
English Sense of Humor Excellent Good Fair Poor

Leadership Excellent Good Fair Poor

Evaluative Statement from Referee:
Ability to interact with others Excellent Good Fair Poor
Please write a one page evaluative
statement on your NGO letterhead and Honesty Excellent Good Fair Poor

submit It with this form. Include reference Responsibility Excellent Good Fair Poor
to strengths and weaknesses of the
Respect for others Excellent Good Fair Poor
candidate, seriousness of purpose, and
Motivation Excellent Good Fair Poor
your estimation of the candidate’s
leadership potential. Curiosity Excellent Good Fair Poor

_____________________________________________________________________
Submit this form and the evaluative COMMENTS
statement via mail, email or fax to:
6.2 How long have you known this candidate? Years: ___________
EMAIL: blamb@sandiego.edu
6.3 In what context have you known this candidate? ____________________________
MAIL: The Hansen Summer Institute on TRANSLATOR’S STATEMENT
Leadership and International Cooperation
University of San Diego 6.4 This section must be filled out by the translator if the original recommendation is not in
English
School of Leadership and Education
Sciences I hereby certify that the above English Translation is a true and accurate rendering of the
5998 Alcala Park original text
San Diego, California 92110-2492 NAME OF TRANSLATOR:

FAX: 619-849-8195 FAMILY NAME FIRST NAME MIDDLE NAME

SIGNATURE DATE