Microsoft word - personal reference form lotan with both logos.doc

Confidential________________________________________________________________ Personal Reference for the Arava Program on Kibbutz Lotan
The Center for Creative Ecology and the Arava Institute for
Environmental Studies
Kibbutz Ketura, D.N. Eilot 88840, Israel, Tel: 972-8-635-6618, Fax: 972-8-635-6634 Email: [email protected] Web Site: http://www.arava.org To the applicant: This form must be completed by someone familiar with you, but not related to you (not a family
member). This referee can be a co-worker, friend, neighbor, employer etc. …).
Name of applicant______________________________________________________________________________
Address______________________________________________________________________________________
Telephone_____________________________________E-
mail___________________________________________

Under the provisions of the Family Educational Rights and Privacy Act,
I have retained my right of access to this recommendation I have waived my right of access to this recommendation I understand that no application documents can be returned after submission to the Arava Institute for Environmental Studies Applicant’s signature_________________________________________Date_______________________________ The above-named student is a candidate for admission to The Arava Institute for Environmental Studies and the Center for Creative Ecology. The Admissions Committee will appreciate your providing information that will be helpful in evaluating the applicant’s academic and personal qualifications. Please comment candidly. All information will be treated confidentially. Please return the completed form as soon as possible to the above address. Thank you. 1. How long have you known the candidate and in what way? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2. What are the candidate’s major interests? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 3. What are your impressions of the candidate’s character and maturity level? Please include his/her ability to adjust to new and intensive situations. _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ (continued on back) 4. Does the candidate have any special strengths, weaknesses, or problems of which we should be aware? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 5. How does this candidate function within a group setting? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 6. We welcome any additional comments that you think will be helpful to us. (Use additional sheets if necessary.) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 7. I recommend this applicant for admission to the Arava Institute for Environmental Studies and the Center for Creative Ecology: Not Name _________________________________________ Position_______________________________________ Address_____________________________________________________________________________________ ____________________________________________________________________________________________ Telephone ____________________________________Email_________________________________________ Signature ____________________________________Date__________________________________________

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