Please photocopy this form as necessary.
Section 1 of this form should be completed by the applicant. The form should then be passed to the referee who is asked to
complete the remainder of the form and return it.
Section 1: To be completed by the applicant
It is important that you provide these details as they are shown in your passport, if you have one.
1. Family Name:
2. Title: Mr
4. Date of Birth:
5. Sex: Male
6. Marital Status: Married
8. Department in which you wish to study:
9. Proposed programme of study:
Please complete the name of the department to which you are applying in the return address below:
Postgraduate Admissions Secretary
The University of Shefﬁeld
Section 2: To be completed by the referee
The above-named candidate is applying for graduate study at the University of Shefﬁeld and has named you as a referee.
We would be grateful if you could provide us with a reference on the academic and general suitability of the applicant to
undertake a programme of postgraduate study, either by completing the form overleaf or by submitting a letter of reference.
If you choose to submit a letter, please use headed paper and attach it to this form.
Please complete this form as soon as possible, and return it in a sealed envelope, endorsed with your signature over the seal,
either to the applicant for return with the application form by mail or, to the return address given in Section 1 above.
Thank you for your assistance.
Relationship to applicant:
Length of time known: