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THE PERCY AND ALICE CHANG EDUCATION FOUNDATION P.O.

Box 180, Kingston 8, Jamaica REFEREES RECOMMENDATION


(Each applicant is required to submit only three recommendations using this form. You may make copies of this form. Only recommendations on this form will be accepted. Do not submit separate letters.)

Jodi-Ann Fletcher .. (Candidates Name) has applied to University of the West Indies .. (Tertiary Institution) to pursue The Bachelor of Medicine, Surgery degree programme .. (Course title). The above named has applied to the Percy and Alice Chang Education Foundation for a scholarship to assist with the above course of study and has named you as a referee. Please answer the following questions as completely as possible, and if you have any further comments, please write them in the space provided. Please limit your comments to the space provided. 1. 2. 3. 4. 5. 6. 7. 8. Full Name of Referee: (Please print) Address: Telephone Numbers: e-mail... Occupation: .. Work Address: . Position Held: ... How long have you known the Applicant? ... In what capacity? ..

(Please circle the most appropriate response) 9. 10. 11. In your opinion do you believe that the applicant has the academic background for the course? In your opinion do you believe that the applicant will be able to do well in the course for which they have applied? To your knowledge is the applicant already involved in some form of community service? Please elaborate: Yes No Yes No Yes No Dont Know Dont Know Dont Know

..

12.

To your knowledge has the applicant demonstrated good leadership qualities? Please elaborate:

Yes No

Dont Know

.. .. 13. From your knowledge, which term in each line best describes the applicant: Always reliable Always works hard Always disciplined Always honest 14. 15. Mostly reliable Mostly works hard Mostly disciplined Mostly honest Sometimes reliable Sometimes works hard Sometimes disciplined Sometimes honest Unreliable Lazy Undisciplined Dishonest

To your knowledge, does the applicant or his/her family have the financial means to cover the cost of a course like this? Yes No Dont know Do you recommend the applicant to receive a scholarship from the Percy and Alice Chang Education Foundation to pursue the above course? Unreservedly Yes Yes with Reservations No

16. .

If you have reservations, please state them below: .. ..

17.

If you have any further comments, please state them below. .. .. .. .. .. . . .

Signed..

Date