Academic Reference Form
You have the option to include an academic reference with your study abroad application, but it is
not required. The form should be completed by a member of the academic staff of Utrecht
University / University College / University College Roosevelt. The referee can also write a letter
instead of using this form.
Name of applicant
Applies to host university
Country host university
The above named student is applying for admission to a partner university abroad within the
Utrecht University student exchange programme. We kindly ask you to comment on the applicant
in terms of academic abilities, personal suitability for living abroad and emotional maturity and/or
motivation and seriousness of purpose. We thank you in advance for your assistance.
1. How long and in what capacity have you known the applicant?
2. Please indicate how you think participation in the exchange programme will benefit
the student. Please be specific.
www.uu.nl/studenten/exchange
www.uu.nl/students/exchange
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3. Please indicate the applicant's ability and academic competence in comparison with
other students whom you have known at similar stages in their academic careers.
4. Please add any additional comments relating to the applicant’s suitability for an
international study experience. For instance motivation, seriousness of purpose,
personal suitability for living abroad and emotional maturity.
Name referee
Position or title
E-mail address + telephone number
Department/ Faculty
Date
Signature
www.uu.nl/studenten/exchange
www.uu.nl/students/exchange
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