Intercultural Programs Reference Form

In addition to the application, students applying to EMU Intercultural programs must have references submitted by each of the following persons: 1) an academic advisor, 2) a faculty, staff or non-family member (pastor, work supervisor, Residence Director, coach, mentor, etc.).

If you are providing a reference for an applicant please complete the following form:

1Personal Characteristics > 2Academics & Work > 3Review
Student's Name Student's Name First Last
Program student has applied for

Program student has applied for Middle East, 6 wks. SU 2025 Switzerland/Germany, 3 wks. SU 2025 DC Urban Sustainability, 3 wks. SU 2025

You may select more than one program. Please indicate all programs to which the student has applied so your comments will go to the correct faculty member/s.
The student wishes to participate in Eastern Mennonite University’s Intercultural Program. Our programs are more than study abroad. They include off-campus learning experiences that immerse students in a new context/culture, often far from the tourist circuit. For international programs, an extended stay with a host family is usually part of the learning experience. Program options include:

1. 3 or 6-week Summer Seminars - Students take the Core Intercultural Social Science course, examining historical, social, religious and economic dynamics that shape a culture. 6-week seminars include a second 3-semester hour course, such as foreign language or another course within the faculty leader's area of expertise.

2. Semester Programs - Offered fall and spring, these programs provide a deeper level of immersion and time for reflection on the student's own cultural biases and values. Students complete 15 SH of coursework, including foreign language if applicable, Intercultural Social Science, and a religion course examining religious expression in the host context alongside Christian identity.
Your Name:
Occupation:
Email:
Phone: Phone: - ### - ### ####
Confidentiality:
The Privacy Act is a Federal Law that states that everyone has the right to know and receive information or copies of documents that are maintained about them by agencies. This law states that EMU may keep the identity of this reference source confidential only upon your request. Please check one of the following.

Confidentiality:
The Privacy Act is a Federal Law that states that everyone has the right to know and receive information or copies of documents that are maintained about them by agencies. This law states that EMU may keep the identity of this reference source confidential only upon your request. Please check one of the following. I DO authorize EMU to identify me as the source of this reference. I DO NOT authorize EMU to identify me as the source of this reference.
How long have you known the applicant?
What is your relationship to the applicant, and in what settings have you had the opportunity to observe them?
Personal Characteristics:
Program participants live with other students and relate with a diverse population of people in a new cultural setting. Travel and unknowns contribute to the intense and demanding nature of many days, in addition to facing new ideas and challenges.

Please enter a number for each category, on a scale of 1-7, with "7" being extremely well developed and "1" being poorly developed. Leave a blank if you have not observed this aspect of character.
Emotional Maturity:

"7" for extremely well developed and "1" for very poorly developed.
Self-confidence:

"7" for extremely well developed and "1" for very poorly developed.
Sense of Humor:

"7" for extremely well developed and "1" for very poorly developed.
Integrity:

"7" for extremely well developed and "1" for very poorly developed.
Responsibility:

"7" for extremely well developed and "1" for very poorly developed.
Leadership:

"7" for extremely well developed and "1" for very poorly developed.
Peer Relationships:

"7" for extremely well developed and "1" for very poorly developed.
Please comment on the applicant’s interpersonal relationship skills. Specifically, is the person outgoing or withdrawn, what role do they play in a group, are they tolerant, flexible or skilled at listening?
What key words come to mind in describing this person?
Describe any exceptional qualities, special interests and unique experiences of the applicant.
Identify any problems or particular struggles this person may have while in the program.
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