Office of Global Initiatives
170 North St/Box 139
Dryden, NY 13053 USA
Email: global@tompkinscortland.edu
www.tompkinscortland.edu/global
Study Abroad Confidential PERSONAL Reference Form
STUDENT Name (Last, First, Middle) Program Location Abroad Primary SUNY Campus
P
lease submit this reference form to the office above
To the Student and Whomever Completes the Reference,
The PERSONAL REFERENCE should be given to a friend or acquaintance who knows the student well and is able to judge their emotional
stability and personal maturity as it relates to study abroad. Anybody affiliated with the trip you are applying to participated in
SHOULD NOT compete this form. A letter of recommendation is also acceptable instead of this form, if desired.
Where to submit: As this letter is confidential, it should be sent directly to the Office of Global Initiatives by the reference. If mailing,
the applicant must provide them with a self-addressed stamped envelope for this purpose. You may submit it yourself if it has been
placed in an envelope and signed over the seal by the person who completed it.
I
waive my right to access this reference completed by ____________________________________________
Yes No
Name of Reference
Student's Signature:_______________________________ __________________Date:___________________
To the Personal Reference: The person named above is applying to participate in one of our College’s academic study abroad
programs, which requires travel in the company of fellow students and professors. Students will be representing the College as
cultural ambassadors while in-country. Since the circumstances of travel can be unpredictable and since what they encounter
may be challenging, flexibility, open–mindedness and cooperation are imperative to the success and safety of the program.
Comment below and on the back on the student’s ability to cope with, contribute to and benefit from this experience as
described. Frankly weigh strong and weak points.
1. H
ow long and in what capacity have you known this person?
2. D
escribe this person’s ability to be open-minded and flexible.
3. W
hat has been your experience with this student’s ability to get along with people different from themselves?
4. H
ow do you imagine the student might benefit from the experience?
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