Confidential Reference Form printable pdf download

Putney Student Travel

345 Hickory Ridge Road, Putney, VT 05346

Phone: 802 387 5000 Fax: 802 387 4276

E-mail:

CONFIDENTIAL REFERENCE FORM

Dear Friend,

has applied for admission to a Putney Student Travel program to_____________________________

and has indicated that you would be willing to furnish us with a reference on his/her behalf. Each applicant is carefully selected

on the basis of his or her maturity, enthusiasm, motivation, intellectual curiosity, and potential to thrive within and contribute to a

close community environment. To learn more about Putney’s programs (Community Service, Global Action, Language

Learning, Cultural Exploration, Excel, and Putney Foundations), please visit our website:

Your reference is a valued and important part of our admissions process and your honest responses carry

significant weight. If you feel uncomfortable recommending the applicant, you should simply sign and return

this reference form. A BLANK FORM WILL BE REGARDED AS A NEGATIVE REFERENCE.

ALL INFORMATION YOU PROVIDE IS CONFIDENTIAL. References submitted to Putney are read only

by members of the Admissions Committee and leadership staff. Since we are not able to act on the student’s

application until all reference forms are complete and returned to Putney, your prompt reply will help our

admissions committee make its decision in a timely fashion. Thank you for your help!

1. How long have you known the applicant? In what capacity?

2. How long has the applicant attended his/her current school:_________________________________

3. Academic standing: Using a scale of 1 to 10, with 10 being the highest possible rating, please indicate how you

feel the applicant compares to his/her peer group as a student in the following areas:

Diligence:_______ Motivation:______ Intellectual Curiosity:_______ Academic Achievement:________

4. Has the applicant ever been involved in disciplinary action, placed on probation, or suspended from school? If

yes, please explain.

5. Are you aware of any emotional, behavioral, or medical issues that may affect the applicant' s ability to be an

active and constructive member of a small group of peers or a residential academic program?

6. Please comment on the likelihood that the applicant would be a constructive and positive member of a small group

of peers and leaders, who are supportive of one another and open to new experiences and challenges.

Confidential Reference Form