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) \ 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. .