Get Common Confidential Form 2013-2024

COMMON CONFIDENTIAL REFERENCE FORM ADMISSION TO NEW ZEALAND TERTIARY ACCOMMODATION SECTION A Applicant to complete NSN Number Legal Surname/Family Name Year applying for First/Given Name s Gender Please forward this reference to the following tertiary institution/institutions Date of Birth i. ii. Male Day Female Month Year SECTION B Referee to complete Note This form is important in the selection process. Full and frank comments are appreciated* 1. Please make appropriate comments and then mark box with one of 1 Outstanding 2 Above Average 3 Average 4 Below Average 5 Poor Attitude to independent study/self discipline/time management skills 1-5 Ability to relate to/show concern for others Personal behaviour and maturity level including alcohol and drug abuse 1-5 Self confidence/self reliance/adaptability to new situations Academic ability 2. Are there any concerns/special needs that we should be aware of so that appropriate support can be provided e*g* health problems anxiety depression home situation disability eating disorders 3. Anticipated overall outcome for Year 13 study in NCEA Level 3 or other qualifications New Zealand schools only NCEA Mostly Excellence Mostly Merit Mostly Achieved or specify International Baccalaureate IB grade Above 40 40-35 34-31 30-25 24-20 Cambridge International Examinations CIE grade Mainly A Level UCAS Tariff Score Even split 280 or above 279-250 209-170 169-130 129 or less 4. This candidate s suitability for tertiary accommodation Highly Recommended Recommended Other 5. General comments if you require additional space for your comments please write on the other side of this page 6. Referee Name Signature Position/Relationship to applicant School/Organisation Name Phone Email Date This reference is being requested on the understanding that it will remain confidential to those concerned with considering applications for the type of accommodation specified by the applicant and those who may subsequently be entrusted with the applicant s pastoral care and will not be used for any other purpose. The Official Information Act 1982 and the Privacy Act 1993 provide protections for evaluative material and the University will decline to release or allow access to such material when requested by other parties to the full extent authorised by those provisions. ii. Male Day Female Month Year SECTION B Referee to complete Note This form is important in the selection process. Full and frank comments are appreciated* 1. Please make appropriate comments and then mark box with one of 1 Outstanding 2 Above Average 3 Average 4 Below Average 5 Poor Attitude to independent study/self discipline/time management skills 1-5 Ability to relate to/show concern for others Personal behaviour and maturity level including alcohol and drug abuse 1-5 Self confidence/self reliance/adaptability to new situations Academic ability 2. Full and frank comments are appreciated* 1. Please make appropriate comments and then mark box with one of 1 Outstanding 2 Above Average 3 Average 4 Below Average 5 Poor Attitude to independent study/self discipline/time management skills 1-5 Ability to relate to/show concern for others Personal behaviour and maturity level including alcohol and drug abuse 1-5 Self confidence/self reliance/adaptability to new situations Academic ability 2. Are there any concerns/special needs that we should be aware of so that appropriate support can be provided e*g* health problems anxiety depression home situation disability eating disorders 3.