Revised Oct. 2018
APPLICANT: PLEASE COMPLETE THIS SECTION
APPLICANT NAME (PRINT):
APPLICANT EMAIL:
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 _________________
TO THE EVALUATOR:
The National Student Exchange (NSE) provides students with the opportunity to attend another
university within the United States, its territories, and Canada for up to one year. Students participate in
NSE to take advantage of the unique geographic, cultural, and academic characteristics of the institution
and region.
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 will 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 state clearly your opinion of this applicant's chances for academic and non-academic success in
an exchange program.
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:
(Please complete reverse side.)
University of Hawai‘i at Hilo Reference Check
National Student Exchange Program
