STATE UNIVERSITY OF NEW YORK CONFIDENTIAL REFERENCE FORM
Overseas Academic Programs Academic Reference #1
________________________________________________________________________________________________________________________
Your Name Program Location Abroad Administering SUNY Campus
________________________________________________________________________________________________________________________
Address of International Education Office at Administering SUNY Campus
OAP 4
To the Student
This academic reference should be given to a professor who knows you well and is able to judge your academic qualifications for
study abroad. A letter of recommendation on letterhead is also acceptable.
As this letter is confidential, it should be sent directly to the Administering SUNY Campus by the person writing the letter. You must
provide a stamped, addressed envelope for this purpose. You may submit this letter yourself if it has been placed in a sealed envelope
and has been signed over the seal by the person writing the reference.
I waive my right to access this reference completed by _________________________________________________
Yes
Name of Reference
Student's Signature:____________________________________________________________________ Date:___________________
To the Reference Please return this form to the International Education Office at above address.
The student named above is applying for the designated State University of New York overseas academic program. We would
appreciate your assessment of the applicant's attributes with which you are familiar. You may also attach a letter of recommendation.
How long and in what capacity have you known the student?___________________________________________________________
Academic attributes
Excellent Very Good Good Fair Poor No Evaluation
Competence in major or specialization
Academic interest and motivation
Capacity for independent study
Resourcefulness
Reliability
Integrity
Non-academic attributes
Excellent Very Good Good Fair Poor No Evaluation
Level of maturity
Ability to adapt to new or unstructured circumstances
Self-confidence and self-esteem
Ability to relate well to others
Emotional stability
Open-mindedness
Integrity
Please state frankly your opinion of this candidate's ability to suitably represent both their home campus and the USA in a
study abroad program, weighing both strong and weak points. Please use the space below or the reverse side of this page. You
may also add or attach a letter of recommendation.
Your Name (please print)__________________________________________Title, Department:______________________________
Signature: ____________________________________Date:___________________ Institution:______________________________
