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Ethhiopia St. Giyorgis Church, Lalibela: Photo by Dr. Wosene Yefru

XVI. Confidential Reference Form (Form 202)

I agree to waive --- my right to access to this reference completed by------------------------------------------

                                                     Or

I do not agree to waive my right------ Student Signature-------------------------------------------------------------

The student must complete this part and sign this form whenever requesting a reference.

This student is applying to join the summer field studies program sponsored by Tennessee State University. We would very much appreciate if you assess the student’s potential and capabilities to be in the field studies program.

1.       Basis and extent of your acquaintance with the applicant:--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

2.       Academic attribute (please use the figure 1-5 No. 5 being excellent):

Competence in major field of Studies----

Academic interest and motivation------

Capacity for independent study-----

Resourcefulness----

Reliability---

3.       Non-academic attribute

Ability to adopt to a new environment—

Self-confidence and self-esteem---

Ability to relate well to others---

Level of maturity---

Emotional stability---

Open mindedness---

Integrity---

Honesty---

4.       Please briefly state on a letter head the applicant’s chances of success in the field studies program and send it directly in the address written below.

Evaluator’s Name (print)-------------------------------------------------------------------------------------------------

Title----------------------------------------------------------- Signature---------------------------------------------------

Address-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Please send to:

Wosene Yefru, Program Director

Summer Field Studies Program

Department of Africana Studies

P.O. BoX 9054

Tennessee State University

3500 John Meritt Blvd.

Nashville, Tn 37209