Open Reference Form

2015 16
O ce use only

APP. DATE

APP. NUMBER

To the Student
After you complete the information below, give this form to your referee. Your referee can be any person who has taught you or
with whom you have worked for a period of at least 2 years. The reference of a relative is considered invalid. This form should
be mailed to the Srish
ce with the completed application form.
Name

middle

last

Address

To the Referee
Thank you for agreeing to provide a referral for the applicant. Please complete this form in its entirety.
Occupation

Name of the referee

How many years have you known the applicant?
In what context (s) have you known the applicant?
Address of the referee

Email

Tel No.

RATING (Please Tick)

Social adaptability

Below average

Average

Good

Very Good

Excellent

No basis of judgment

Emotional adaptability
Leadership
Motivation
Disciplined work habits
Integrity and honesty
Academic ability
Willingness to go beyond
the expected

Signature

Date

Srishti Institute of Art, Design and Technology

SRISHTI, 40/D, 2nd Cross, 5th Main, Shiva Mandir Road, Yelahanka, Bangalore 560 106, KARNATAKA
T +91 80 4900 0830 / 4900 0823 F +91 80 2856 0950 E admissions@srishti.ac.in W srishti.ac.in
...2

Reference Form 2015 16

Please indicate how you know the applicant, how long and in what capacity you have known him/her. Please elaborate if
you believe this student is capable of undertaking a rigorous academic commitment and what the applicant's abilities are
for independent and original work. Please include any other information that you believe would be helpful in our evaluation
of the applicant.

Signature

Date