STUDENT EXCHANGE PROGRAMME: REFEREE FORM

SECTION A – to be completed by the applicant

Instructions to the Student:

Please complete Section A then give a copy of this form to at least one Massey University academic staff
member in the area of your major AT LEAST ONE WEEK BEFORE THE DEADLINE DATE.

First Name: .................................... Surname: .................................................

Student ID: .................................... Programme of Study: ...............................................
Semester of Exchange: ……………… Year of Exchange: ……………………………………..
Proposed Exchange Destination: ………………………………………………………………………..
SECTION B – to be completed by Referee

Notes for Referee:

The above student is applying to the Massey University Student Exchange Programme. Your comments on
the student’s suitability for this programme would be very much appreciated. This reference is treated as
confidential and forms part of the application documents that will be presented to the Massey Student
Exchange Selection Committee prior to the interview with the applicant. If the student’s application is
successful then this documentation will also be forwarded to the host institution overseas. This Reference
Form should not be returned to the student but to the International Programmes Administrator as
noted overleaf.

Deadlines: Please forward the reference to the International Programmes Administrator by the following
dates:

1 June for commencement of studies overseas in (Massey) Semester One the following year
1 October for commencement of studies overseas in (Massey) Semester Two the following year

In special cases, and provided the student has consulted with the International Programmes Coordinator,
applications will be considered after the due date.

Requirements
Referees are asked to assess, where possible, the applicant’s suitability as an exchange student. This
includes comment on whether or not the student’s official record is a reasonable representation of his/her
academic ability and whether the proposed exchange will advance the student’s academic career.
Comments are also sought upon whether the students will benefit personally, socially and culturally from the
exchange, and whether the applicant would make a good ambassador for Massey University when overseas.

1. Please indicate the applicant’s ability and academic competence in comparison with other individuals
you have known at similar stages of their academic career.

Outstanding Excellent Good Average Poor Unable to

(Top 2%) (Top 10%) (Top 20%) (Top 50%) (Low 50%) Judge
Academic/Intellectual
potential
Motivation/seriousness
of purpose
Maturity

Emotional Stability
Ability to adapt to new
circumstances
Ability to work with others
Overall rating of
candidate

November 2009
2. For how long, and in what capacity, have you known the applicant?
………………………………………………………………………………………………………….…
……………………………………………………………………………………………………….……
………………………………………………………………………………………………..……………
…………………………………………………………………………………………………..

3. Please comment on the relevance of the proposed overseas programme to the applicant’s current
programme of study:
………………………………………………………………………………………………………..……
…………………………………………………………………………………………………..…………
…………………………………………………………………………………………………….………
…………………………………………………………………………………………………..

4. Please comment on any areas in which the applicant might be relatively weak:
……………………………………………………………………………………………………….……
…………………………………………………………………………………………………….………
………………………………………………………………………………………………….…………
………………………………………………………………………………………………….

5. Please comment on the ratings above and make additional comments regarding the applicant’s
suitability for a programme of foreign study. In your comments, you may also include non-academic
aspects such as motivation, student’s ability to adapt to new environment and cultures, leadership, good
character, outgoing and social personality, etc.
……………………………………………………………………………………………………….……
…………………………………………………………………………………………………….………
………………………………………………………………………………………………….…………
………………………………………………………………………………………………….

6. Do you recommend the applicant for the Massey University Student Exchange Programme?
(please indicate) Yes No

Referee Information:

Name: ............................................ Designation: ......................................................

College: ............................................ Telephone Ext: ......................................................
Date: ............................................ Signature: ......................................................

PLEASE DO NOT GIVE THIS COMPLETED REFERENCE TO THE STUDENT

Please forward in an envelope marked “CONFIDENTIAL” to:

the International Programmes Administrator, International Office, Mail Code PN721
Massey University, Private Bag 11-222, Palmerston North
Email: Studyabroad@massey.ac.nz Telephone: (06) 356 9099 ext. 81495

November 2009