SV01-PE PERSONAL EVALUATION FORM - Wintec

SV01-PE
PERSONAL EVALUATION FORM
Please complete and return this form along with the Application
for Accommodation form to:
WINTEC Student Village
PO Box 103
Hamilton 3204
TO THE REFEREE:
The applicant whose application form accompanies this
personal evaluation form has applied to reside at
Wintec Student Village for the duration of their study at
Wintec in 2013.
The Village is a hall of residence which provides residents
with a living learning experience. The Village and
its staff aim to facilitate an environment which fosters
academic success and encourages the social, cultural
and personal development of each of its members.
To ensure the success of these aims we endeavour to
select students who demonstrate a serious commitment
to study, who will be considerate of other residents and
neighbours, who will adapt readily to village living with a
minimum of supervision, and who will make a positive
contribution to Village life.
As we do not conduct personal interviews we rely heavily
on the information that you provide. Full and frank comments
are appreciated.
APPLICANT’S NAME ____________________________________________________
REFEREE’S NAME ______________________________________________________
REFEREE’S CONTACT NUMBER ____________________
Once you have completed this form, either return to
the student for posting back with his/her Application
Form or return it separately to;
Wintec Student Village
PO Box 103
Waikato Mail Centre
Hamilton 3204
Applications for a full year or semester one 2013 close
at 5pm on Friday 26th October 2012. Applications for
semester two or casual accommodation are accepted
any time prior to arrival.
WHO CAN BE A REFEREE?
A referee should be a person who is not related to, nor
do they have a personal relationship/friendship with, the
applicant. The referee should have known the applicant
in a professional capacity for a period which would allow
them to be able to answer the questions below. The referee
would preferably be a School Teacher, Dean or
Principal. A work supervisor would be acceptable for
applicants that are not currently at High School.
PLEASE NOTE: THE INFORMATION YOU PROVIDE WILL REMAIN COMPLETELY CONFIDENTIAL AND WILL ONLY BE
SEEN BY THE SELECTORS. THIS INFORMATION WILL NOT BE DISCLOSED TO THE APPLICANT.
PERSONAL EVALUATION
Please make appropriate comments and then mark the box with one of the following grades:
1=Outstanding, 2=Above Average, 3 Average, 4=Below Average
Description
Attitude toward independent
study/self discipline/time
management skills
Ability to relate and show
concern for others
Personal behaviour and social maturity
Self-confidence/self reliance/
adaptability to new situations
Academic Ability
Choose
between
1—4
Comments (compulsory)
Demonstrates enthusiasm to contribute/participate
in
activities.
PLEASE TURN OVER AND COMPLETE REVERSE

Are there any concerns/special needs that we should be aware of so that appropriate support can be provided?
(e.g. health problems, home situation, disability, eating disorders)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Anticipated overall outcome for current years academic performance (schools only):
Mostly Excellence Mostly Merit Mostly Achieved
This candidate's suitability for tertiary education accommodation:
Highly Recommended Recommended Recommended with reservation
Other ____________________________________________________________________________________
_________________________________________________________________________________________
General Comments: _________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Relationship to applicant: ____________________________ Signature: ______________________________