Reference Form

This student is applying for admission to Carleton University’s Enriched Support Program. Your reference is one component of several (including grades and the applicant’s personal statement) that will be considered in determining this applicant’s admissibility. The information provided will be kept confidential and only reviewed by the ESP Admissions Committee.

Please complete this form providing your work email address. A copy of your reference will be sent to you. Note: forms returned by email from a non-school board, college, or university (as applicable) email address will not be accepted - a measure taken to address possible fraudulent submissions.

Applicant's Name*

First Last

Referee's Name*

First Last

Referee's Title*

School*

Phone Number (work)*

Ext.

Email Address (work)*

Is there a way we can contact you (if necessary) after the school year has ended? (phone or email?)*

Please rate the applicant in the following areas, where: 5= very strong, 3= average, 1= needs development, DK= Don't Know

Ability to work with others*

Interpersonal skills*

Ability to be resourceful/self-directed*

Communication skills, written*

Communication skills, oral*

Willingness to receive feedback*

Maturity*

Class attendance*

Overall assessment*

What class(es) did the student take with you? And what were the approximate grades received?*

Please comment on the applicant's performance in your class(es). What are the student's academic strengths and what areas need development?*

If you are aware of any reasons why the student's work may have not reflected the level of his/her ability, please include this information.

The Enriched Support Program requires students to learn in collaborative settings. Please comment on this applicant's interpersonal skills and ability to work with others in groups.*

Has the student's behaviour presented any difficulties?*

In your opinion, is this student suited to and ready for university level work? Why or why not?*

Consent*

I agree to the privacy policy.

The personal information requested on this form is collected in accordance with Sections 38(2) and 41(1) of the Freedom of Information and Protection of Privacy Act (FIPPA), R.S.O. 1990, c.F.31 as amended. The information provided will not be used for any purposes other than those stated upon this form unless you give your consent. Should you have any questions concerning your personal information please contact Susan Burhoe, FIPPA Representative for the Centre for Initiatives in Education. Carleton University is fully compliant with FIPPA and endeavours at all times to treat your personal information in accordance with this law.

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ESP Reference Form

Please rate the applicant in the following areas, where: 5= very strong, 3= average, 1= needs development, DK= Don't Know