GRADUATE SCHOOL

Application for Admission to

Masters Degree Program by Coursework
Confidential Recommendation Form

Part A (To be completed by applicant)

Name of Applicant : G. Wiro S.
Programme Applied for : Master Of Acupuncture and Moxibustion
Application No. :
Date : 2nd February 2017

Signature of Applicant :

Part B (To be completed by referee)

1. How long and in what capacity have you known the applicant?
I have been known Mr.Wiro For 8 years, since he was my medical student whom I taught many basic
medicine subjects. He was one of the representative of his rural regency who awarded for local
government scholarship programme for medical student.
2. What do you consider to be the applicants strength(s) and weakness(es)?
Since the first time I met my students, I observed their capability. I was Mr.Wiros lecturer. I had
supervised many of

his medical case reports. During his study and medical training, he had

demonstrated an exceptional academic performance. Since I was appointed as Students Affair Chair
Person, I knew many activities he has been done along his study. He has been involved in several
volunteer activities and student empowering programs.
For what i have known about his personality, the strenght of him is his excellent motivation for
reaching his target or purpose. He always try to do the task on time. He diligently asked me for my
consulting advise in his tasks, even in our busy schedules. He was a passionate person in dealing with
challenging patients. His weakness is sometimes he is being impatient, he could stand for something
he could precisely afford.
3. Please rank the applicant, in comparison to other students or employees whom you have known
in similar capacities, with respect to the following criteria . (Please indicate by putting ticks in
appropriate boxes.)

Characteristic
Intellectual Ability
Chinese Proficiency
English Proficiency
Emotional Maturity

Outstanding

Excellent

Good

Average

Below

Unable

(Top 5%)

(Top 15%)

(Top Third)

(Middle)

Average

to Assess

Capacity for Problem Solving

Diligence
Team Spirit
Research Ability
Motivation for Postgraduate Studies

4. Please add any comment you think will be of assistance in assessing the applicant. A separate
sheet may be appended if necessary.
The fact that he has graduated his professional education as a medical doctor at Tanjungpura
University and has always been concerned about efforts to improve health of Indonesian society, I am
convinced that your master program would contribute to help him being a profesional acupuncturist
that will provides health services for his regency.
I hope these descriptions are helpful to recommend Mr. Wiro applying the master program at your
institution. Please do not hesitate to ask if you have any question about him.
5. Would you recommend the applicant to pursue postgraduate studies for Masters Degree
programme? (Please put a in the appropriate space.)
Highly Recommended
Recommended
Not Recommended
2nd Februari 2017
Best regards,

Virhan Novianry, MD, M.Biomed

Third Vice of Dean
Faculty of Medicine,
Tanjungpura University
Jl. Prof. Dr. H. Hadari
(+62) 811 571 2364
drvirhannovianry@gmail.com