Applicant’s Name: ______________________________________________

University: ____________________________________________________

REFERENCE
Please provide us with comments on the applicant’s strength, weakness or personal qualities which you
believe would be helpful in considering the applicant’s application for this program.

Please provide the name of your recommender.

Name: _____________________________________________________________
Position: ____________________________________________________________
Address_____________________________________________________________
Telephone: _________________________ Fax: ____________________________

I, the undersigned, hereby acknowledge, under the penalty of perjury, that the foregoing
information is true and correct to the best of my knowledge.

Applicant Signature Dated

__________________________ ____________________________

Authorized Person Signature Dated

(Preferable Director of International Relation Office)

__________________________ ____________________________
Position ____________________

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