REFEREE REPORT CONFIDENTIAL

Institut
Pengajian Siswazah
For Admission to Postgraduate Studies

SECTION A: TO BE COMPLETED BY THE APPLICANT

Applicant’s Name: FAIQOH LAILATUZ ZAIM
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I.C No. / Passport No: 6201024101980004 / X1039177

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Post Graduate Degree applied for: MASTER OF SCIENCE (CHEMISTRY) (AS756)

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Faculty: Applied Science by Research

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Proposed Research Area: Environmental Chemistry

SECTION B: TO BE COMPLETED BY THE REFEREE
(One of whom must be an academic referee)
Name of Referee:
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Amri Setyawati
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Title: M.Sc.
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Address of Organization: Jl. Kaliurang Km.14.5, Ngemplak, Sleman, Yogyakarta, Indonesia

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Phone Number: 085646460319 Fax Number: +62 (274) 896439

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Email: amrisetyawati@uii.ac.id
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1. Knowledge of the Applicant

Approximately how long have you known this applicant: 2
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years.
How well do you know the applicant? Kindly tick (✓):
Casually ✔ Well Very Well
In what capacity have you known about the applicant? Kindly tick (✓):
Lecturer ✔ Research Advisor Employer Others (specify)
2. Evaluation - Kindly rank the applicant as follows:

0 = Unable to rank 1 = Poor 2 = Fair 3 = Good 4 = Very Good 5 = Outstanding

Others Rank Remarks
Knowledge in area of proposed study 4
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Ability to grasp new concepts 5

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Originality, intellectual creativity 4

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Mathematical and logical thought 5

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Written communication skills 4

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Oral communication skills 4

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Teaching ability (if known) 4

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Research ability (if known) 5

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Perseverance toward goals 5

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Maturity and emotional stability 5

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Ability to work well with others 4

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General preparation for post-graduate work 4

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3. Recommendation: Considering this applicant’s academic record, special abilities, ambition and determination. Kindly
indicate your recommendation and tick (✓):
✔ Recommend Strongly Recommend with reservation

Recommend Cannot Recommend

4. Additional Comments – Please add any comments, which you feel will assist in evaluating the applicant’s potential to
pursue postgraduate study.

She has good literature abilities, and good logic to create state of the art of research. She also creates her own
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working timeline and able to quickly complete it. Clear explanations or directions and positive discussion will easily
provoke her with some new ideas. To expand her ability, she should be gathered with people with positive energy to
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bring her more confident about her achievements and improve her public speaking.
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Amri Setyawati, M.Sc. August/30/2020

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Referee Signature Date

Application for Research Programme, kindly attach the proposed research with your
application form and send to the respective faculty.