QUEENSBOROUGH COMMUNITY COLLEGE, CENTER FOR
INTERNATIONAL AFFAIRS, IMMIGRATION, AND STUDY
ABROAD, L-431, 222-05 56 th
AVE., BAYSIDE, NY 11365
(718) 631-6611 DEADLINE: NOVEMBER 11, 2015
Part I: To be completed by the applicant.
Name of Applicant Date of Request
Evaluator's Full Name Position
Under US federal law (Section 438 of Public Law 90-247, as amended), students are permitted access to certain educational records. Section
438(a)(2)(B) provides that a student may waive the right to inspect confidential letters of recommendation. Many applicants have found that recommendation letters may have a greater effect when such letters are written in confidence. If you waive your right to inspect the information requested by this form, please sign below.
Applicant’s Signature
Date
BE SURE TO PROVIDE THE EVALUATOR WITH A SELF-ADDRESSED ENVELOPE
Part II: To be completed by the evaluator. Please be sure to complete the form, insert into a sealed envelope, and sign the back before returning it to the student.
The above-mentioned applicant is applying for the overseas academic program designated above. We would appreciate your assessment of the applicant’s attributes with which you are familiar. Please return this form in the stamped, addressed envelope provided to you by the applicant. You may elaborate with specific examples in the space provided for Item 3 on page 2 or in a separate reference letter.
1. Please indicate the applicant’s academic attributes.
Excellent Good Fair Poor N/A
Punctuality/Attendance
Academic interest and motivation
Capacity for independent study/group work
Ability to express thoughts in speech/writing
Timely submission of assignments
Compliant with guidelines
2. Please evaluate the applicant’s suitability for program participation.
Excellent Good Fair
Ability to adapt to new or unstructured circumstances
Poor N/A
Self-reliance/independence
Ability to relate to and work well with others
Emotional stability
Open-mindedness
Integrity/Personal Responsibility

3. Please describe the basis and extent of your acquaintance with the applicant and state your opinion of this candidate's chances for success (both academic and non-academic) in this study abroad program.
Please keep in mind the following: academic/personal suitability for study abroad; how an international experience may benefit the applicant, both academically and personally; and strengths which you believe the applicant might bring to such an experience. Please use the space on the next page and/or attach a reference letter with your comments.
Evaluator's Signature
Position/Title
Office Address
Date Print Name
Telephone Number