APPLICANT: PLEASE COMPLETE THIS SECTION.
Applicant's Name
In compliance with the Family Education Rights and Privacy Act of 1974, the candidate may have access
to this evaluation unless access is waived by completing the following statement:
I, ______________________________________, waive my right to access this evaluation.
Signature _____________________________________ Date _________________
The National Student Exchange (NSE) provides students with the opportunity to attend another
member university within the United States, Canada, Guam, Puerto Rico and the U.S. Virgin Islands for a
single term or an academic year. Students participate in NSE to take advantage of the unique
geographic, cultural, and academic characteristics of institutions and/or regions.
In making decisions on the appropriateness of a student's participation in the exchange, we need to
know about their motivation, adaptability, academic skills, and those personal qualities that will give
students the ability to benefit fully from the exchange experience. While we appreciate any
observations that will assist us in evaluating the present applicant, of special interest are qualities such
as competence, independence, assertiveness, resourcefulness, quality of performance, confidence,
social skills, open-mindedness and integrity.
Please indicate the basis and extent of your acquaintance with the applicant. Placing your remarks in a
comparative perspective will further assist the NSE office in reaching a decision about the applicant.
In summation, please state frankly your opinion of this applicant's chances for academic and non-
academic success in an exchange program, weighing both strong and weak points.
NOTE TO ACADEMIC ADVISOR (If applicable)
Occasionally, an academic advisor has not had enough contact with a student to do an adequate
personal evaluation. However, in that situation we would like a statement regarding your willingness to
work with the student to determine where courses taken at the host campus will fit into the student's
home academic program. We would also like to know the appropriateness of exchange at this time in
the student's program of study. We are particularly concerned that the student’s academic progress will
not be hindered by participating in NSE. Those statements can be entered in section 4 on the reverse
side of this form.
Reference
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1. How well do you know the applicant? (Check the most appropriate response.)
Extensive contact in a variety of settings
Well acquainted in classroom or campus environment
Limited contact in classroom or campus environment
Other ______________________________________________________________________
2. In comparison with other students whom you have known at comparable stages of their education,
please rate the applicant in these areas. (Circle the most appropriate response.)
Below Unable to
Excellent Very Good Average Average Judge
Academic Ability 4 3 2 1 X
Maturity 4 3 2 1 X
Cooperation and Adaptability 4 3 2 1 X
Initiative and Motivation 4 3 2 1 X
Social Skills 4 3 2 1 X
Open-mindedness 4 3 2 1 X
Integrity 4 3 2 1 X
Independence 4 3 2 1 X
Resourcefulness 4 3 2 1 X
Self-Confidence 4 3 2 1 X
3. Exchange to another campus would be appropriate for the applicant: Yes No
4. REMARKS
Based on your knowledge of the applicant, please comment on his/her chances for success and
what would be gained from an exchange experience.
Faculty/Staff Other: ___________________________
Name
(print) ___________________________________ Position or Title _______________________________
Phone ________________________ e-mail _____________________________________
Signature __________________________________ Date _____________________
Please return to: Trish Gandu, Cohen Honors College, Shocker Hall building A
1845 Fairmount, Wichita, KS 67260-0102
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