Summer Work Travel Program Reference Form 2015
This reference must be completed by a suitable individual a teacher, employer or mentor who knows
you well. Friends or family are not acceptable.
Name of applicant ____________________________________________________________________
Name of referee and job title ____________________________________________________________
Referee contact details ________________________________________________________________
(companys name and address if this is how you know the applicant)
Telephone ____________________________________Email _________________________________
What is your connection with the applicant? ________________________________________________
(personal friends, colleagues, family and family friends cannot be referees)
How long have you known him/her?
(please give dates) ___________________________________________
How would you rate his/her personality and suitability for working and traveling in the USA:
Outstanding
Good
Fair
Low
Cooperation
Communicativeness
Energy
Enthusiasm
Flexibility
Initiative
Leadership
Organization
Responsibility
Sociability
Tolerance
Level of English
Please comment on the applicants suitability for an exchange program in the United States.
Signature
_______________________________________________ Date ____________________