Personal Reference Form

To The STudenT:

Please ll in the following section and give this form to a person of authority who knows you well. Include a

stamped envelope addressed to the Oce of Student Aairs, c/o Reenrollment Committee, Hampden-Sydney

College, P. O. Box 5, Hampden-Sydney, VA 23943. Please type or print in ink.

Your Name _________________________________________________________________

FIRST MIDDLE LAST JR, III, ETC.

Address ___________________________________________________________________

STREET CITY & STATE ZIP CODE

To The RecommendeR:

Please return this form, in the envelope provided, to the Ofﬁce of Student Affairs, c/o Reenrollment Committee

P. O. Box 5, Hampden-Sydney College, Hampden-Sydney, Virginia 23943.

e student named above is applying for reenrollment to Hampden-Sydney College. e Reenrollment

Committee nds candid evaluations helpful in choosing from among highly qualied applicants.

We are primarily interested in whatever you think is important about the applicant’s academic and personal

qualications for college. We would appreciate if you would submit your reference promptly. We are grateful for

your assistance.

Materials submitted in support of an application for reenrollment to Hampden-Sydney College are used

only by those members of the Reenrollment Committee charged with the responsibility of reenrollment decisions.

In accordance with the Family Educational Rights and Privacy Act of 1974, however, enrolled students do have

access to their permanent les, which may include forms such as this one. Since we value your comments highly,

we ask that you complete the form with the knowledge that it may be retained in the student’s le, should the

candidate reenroll at Hampden-Sydney College.

BackgRound InfoRmaTIon

Recommender’s Name (print) __________________________________________________

Address ___________________________________________________________________

STREET CITY & STATE ZIP CODE

How long have you known the applicant? ________________________________________

Note any capacity in which you have known the applicant (employer, relative, family friend,

etc.): _____________________________________________________________________

_________________________________________________________________________

Signature ________________________________________________ Date ___________

(over)

RecommendaTIon of applIcanT

Reenrollment

Application

Personal Reference Form

foRm due daTeS:

JulY 1

- fall SemeSTeR

dec. 1

- SpRIng SemeSTeR

apRIl 1

- SummeR TeRm

Recommend

strongly

Recommend very

enthusiastically

Recommend

fairly strongly

Recommend with

reservations

Prefer not to

recommend

For intellectual promise

For character and personal promise

For overall consideration

PERSONAL REFERENCE FORM FRONT

chaRacTeR & peRSonalITY RaTIngS

Compared to other students applying to selective colleges, check how you would rate the applicant.

What are the rst words which come to mind to describe the applicant?

____________________________________________________________________________________________________

Personal characteristics:

____________________________________________________________________________________________________

Academic characteristics (if known to you):

____________________________________________________________________________________________________

Please use this space for additional comments (if any): __________________________________________________________

____________________________________________________________________________________________________

PERSONAL REFERENCE FORM BACK

Good

(above average)

Average

or below

Excellent

(top 10%)

Outstanding

(top 2 or 3%)

No basis

for judging

Intellectual Ability

Personal initiative

Creative qualities

Self-discipline

Growth potential

Leadership

Self-condence

Warmth of personality

Sense of humor

Concern for others

Emotional maturity

Reaction to criticism

Relationship with peers