INSTRUCTIONS

TO STUDENT: Complete the information on the top of this form. Please ask one of your teachers, who knows you well, to complete this form. If you can-
not choose a teacher, you may choose your school director or a teacher from a school you have recently attended. This form must be completed and
returned with your application by the due date shown on FORM 1.
TO RECOMMENDER: Please answer the questions and sign this document. Your answers to the questions on this form will be evaluated along with the
students own application materials to determining his/her suitability for this scholarship program. Therefore, we ask you to answer each question honest-
ly, carefully and completely. Return the completed form to the student, who will attach it as part of the application. This form must be filled out in English
and have the school stamp. If the recommender does not know English, he or she will be provided with the questions on this form translated into his/her
native language. The recommender must fill out the native language Form 4 in his/her native language. The native language Form 4 will then be translated
into English onto the original Form 4. The English (original) Form 4 must be signed by the recommender and have the school stamp. The Translators
Statement must be filled out by the translator. Neither the applicant nor a member of the applicants family may translate Form 4. Both the English and
local language versions (if original is not in English) of Form 4 must be returned with the application.
RECOMMENDATION FROM TEACHER
STUDENT NAME: ______________________________________________________________
Last Name First Name Middle Name
School Name and Location: _______________________________________________________
Current class (circle one): 8 9 10 11 12 other _________________________
Form 4
4.1 Please describe this student's behavior. How does the student respond to authority? How does he/she relate to peers and participate
in group projects with other students? What talents, interests and skills does this student have that will contribute to an international
exchange experience? Please give examples.
4.2 Please comment on the students motivation in school and study habits.
4.3 Please evaluate the students character in the following categories (check the appropriate boxes):
Personality Traits Excellent Above Average Average Below Average
Maturity
Openness
Leadership
Ability to adapt to new situations
Ability to interact with others
Honesty
Responsibility
Respect for others
Motivation
Curiosity
Knowledge of English (if known)
Comments:
4.4.1 Has the student had any adjustment or disciplinary problems at school? Yes No
4.4.2 Has the student missed or repeated a year? Yes No
4.4.3 Does the student have a history of continuous or frequent absences from school? Yes No
4.4.4 Does the student have any special educational needs? Yes No
If you answered yes to any question, please explain:
RECOMMENDATION FROM TEACHER
4.5 How long have you known this student? Years:
4.6 In what context do you know this student?

4.7 Are you a teacher at the students high school? Yes No If no, explain.

4.8 Check one of the following and explain below:
I feel this applicant is ready to become an exchange student.
I have some reservations about this applicants readiness to become an exchange student.
I do not recommend this applicant.
Please explain:
4.9 This section must be filled out by the translator if the original recommendation is not in English.
I hereby certify that the above English translation is a true and accurate rendering of the original text.
Name of translator: __________________________________________________________________________________________________
Last Name First Name Middle Name
SIGNATURE: Date:
TRANSLATOR'S STATEMENT
RECOMMENDER
Name of recommender: _________________________________________________________________________________________________
Last Name First Name Middle Name
Position of recommender : ______________________________________________________________________________________________
Country: Province: City/Town: ___________________________________
Address: _____________________________________________________________________________________________________________
Telephone: City code Number __________________________________________________________________________
SCHOOL STAMP ( if no stamp, please explain):
SIGNATURE OF RECOMMENDER:
SCHOOL
STAMP
REQUIRED