Reference Form

The person who has sent you this form has applied to participate in a summer work and travel exchange visitor program in the
United States.

The summer work and travel program provides opportunities for university students to experience American cultural and work in
temporary seasonal jobs. The money participants earn is meant to cover basic living expenses.

Part of the extensive application process requires submitting at least one reference from someone who knows the applicant
through an academic institution or employer. The reference should have knowledge of the applicants character and be able to
provide an objective assessment. Family members or friends may not provide references.

Employers are looking for participants who are hard-working, adaptable, and open minded.

Your honest assessment is appreciated. If you have any reservations and wish to share this reference with IENA in confidence,
please contact info@iena.org.

APPLICANT

Applicants Name:

REFERENCE
Your Name: Title:

E Mail Address: Telephone Number:

Company/Institution? What is your connection to the applicant?

If you have employed the applicant, in what capacity? Dates of Employment:

How long have you known the applicant? Your most recent contact?

APPLICANT INFORMATION
Please describe your relationship to the applicant and the interactions you have had with the applicant.

What particular experience, skills, and personal qualities does the applicant possess that makes him/her suitable for this
program?

Would the applicant be able to share his/her cultural with Americans?

Are you aware of any health or other issues which might make the applicant unsuitable for the program?

Would you recommend the applicant for participation in a cultural exchange program?

RATE the FOLLOWING(check the appropriate box)

Excellent Good Fair Poor
Attitude
Adaptability
Responsibility
Tolerance
Enthusiasm
Leadership
Initiative
Patience
Sense of Humor
Loyalty
Maturity
Organization
Warmth
Cooperation
OVERALL RECOMMENDATION(check one)

Excellent Good Fair Poor

REFERENCE SIGNATURE
Signature:
Date:

Address:

IENA
699 Washington Street, STE 203
Hackettstown NJ 07840 USA
Phone/fax: 888 724 4292