Common Confidential Reference Form for Admission to Tertiary Accommodation

Section A: The applicant is to complete. Please print or type.

1. Applicant’s name in full Title: Mr Miss Ms

Surname or Family name First name(s)

What is the highest educational qualification achieved? Give the year, the subjects and the marks or grades or credits achieved

Qualification:______

Year achieved:______

Subjects & marks or grades or credits:______

______

______

______

______

______

______

______

What positions of responsibility have you held? (eg prefect, hockey captain)

What awards have you received?

2. I hereby nominate, instruct and authorise (name of referee) ______to provide the reference (overleaf) and in doing so understand and accept that the report shall remain confidential to the accommodation service of the tertiary institution(s) and/or their nominated agents to which I am making application

3 Tick the institutions/halls listed on Section C to which a copy of this confidential reference is to be sent.

4 Once completed, hand all pages to your referee.

Signature of Applicant Date

______

Common Confidential Reference Form for Admission to Tertiary Accommodation

Section B: The referee is to complete 1 to 7. Please print or type Note: This form is important in the selection process. Full and frank comments are appreciated.

1. Applicant’s name in full Title: Mr Miss Ms

Surname or family name First name(s)

2. Please make appropriate comments and then mark box with one of: 1 = Outstanding, 2 = Average, 3 = Average, 4 = Below Average

Attitude to independent study/self discipline/time management skills (1 – 4)

Ability to relate to and show concern for others (1 – 4)

Personal behaviour and social maturity (including alcohol and drug abuse) (1 – 4)

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Self confidence/self reliance/adaptability to new situations (1 – 4)

Academic ability (1 – 4)

3. Are there any concerns/special needs that we should be aware of so that appropriate support can be provided? (eg health problems, home situation, disability, eating disorders)

4. Anticipated results:

NZ Scholarship NCEA Level 3 University Entrance Or specify

5. This candidate’s suitability for tertiary accommodation:

Highly Recommended Recommended other Recommended with reservations

6. General Comments

7. Name of Referee Position/Relationship to applicant

School/Company

Name ______

Address______

______Signature

Date Phone______Fax ______

COMMON CONFIDENTIAL REFERENCE FORM FOR ADMISSION TO TERTIARY ACCOMMODATION

The applicant is to complete 1 and 2 on this page

1. Name: ______Family/Surname Given Name(s)

2. Tick the institutions / halls to which a copy of the confidential reference (Section B) is to be sent by your referee.

AUCKLAND WELLINGTON CANTERBURY

Auckland University of Technology Victoria University University of Canterbury Residential Manager Accommodation Service The Accommodation Office Akoranga Drive Victoria University University of Canterbury Northcote PO Box 600 Private Bag 4800 AUCKLAND 1009 WELLINGTON CHRISTCHURCH

The Railway Campus Wellington College of Education Lincoln University The University of Auckland Manager, Academic Registry Accommodation Services c/- Accommodation & Conference Centre Wellington College of Education Lincoln University PB 92019 PO Box 17310 PO Box 84 Auckland 1020 WELLINGTON CHRISTCHURCH

Massey University, Albany

Accommodation & Administrative Officer WAIKATO OTAGO PB 102904 North Shore Mail Centre University of Waikato Please write below the address of AUCKLAND Accommodation Services Office the University of Otago Halls of University of Waikato Residence to which the reference is The University of Auckland, PB 3105 to be sent by your referee. (Refer to Accommodation & Conference Centre HAMILTON the address list on the University of The University of Auckland Otago accommodation form) PB 92019 MANAWATU AUCKLAND 1020

Manukau Institute of Technology Massey University ______Manager Residential Services ______Student Services Massey University ______PB 94006 PB 11-222 ______Manukau City PALMERSTON NORTH ______AUCKLAND ______UNITEC ______Accommodation Manager Oak Hall, UNITEC PB 92025 Auckland

REFEREES – PLEASE NOTE THE FOLLOWING

• Photocopy the reference form (Section B) and authorisation detail (Section A) and mail a copy of each to the institutions ticked above by 1 October • Each photocopy of the reference form must be signed (in a colour other than black), dated and stamped with the official school stamp to prevent forgeries. • Retain the originals for your files

N.B. The referee should be your school principal or their nominated representative, if you are still at school. Other applicants should have the form completed by the principal of their former secondary school, an employer or other responsible adult who is not a relative or friend. If you have previously resided in tertiary administered accommodation, the head of that property would be the appropriate referee.