UVic Teacher Education Programs Reference - PDP (Elementary and Secondary) Confidential reference submission form Thank you for completing this confidential reference form for the post-degree professional teacher education programs. We appreciate your time and willingness to support an applicant in their professional endeavours.Referees must be credible authorities who can speak to the applicant’s experiences, interests and abilities relevant to the teaching profession. Please rest assured that this reference form is confidential and will not be shared with the applicant. You must have observed the applicant working in educative ways with groups of children or youth in Kindergarten – Grade 12. References cannot be: family members (including in-laws, step-family, etc.), personal friends or family friends, a classroom teacher whose only relationship to the applicant is as their teacher, a co-worker, someone the applicant taught, tutored, or supervised, or, someone also applying to a UVic teacher education program. You can find more information about the program Experience Requirement on our website.Please complete this reference form and submit by January 2 for those applying for the post-degree professional programs (elementary and secondary). Question Title * 1. Applicant Information First name Last name Student/Applicant number Question Title * 2. Which program is the applicant applying for? Elementary post-degree Secondary post-degree Question Title * 3. Which program location is the applicant applying for? Victoria campus Cranbrook campus (East Kootenay Teacher Education Program) Question Title * 4. Reference Information (your information) First name Last name Email address Phone number Organization name Location (city and province) Question Title * 5. Please describe your relationship to the applicant, and the context in which you observed them working with children/youth. Question Title * 6. In what role and during what time period did you observe the applicant engaged with children/youth? Question Title * 7. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown Leadership skills (ability to plan and lead) Leadership skills (ability to plan and lead) Exceptional Leadership skills (ability to plan and lead) Very Good Leadership skills (ability to plan and lead) Good Leadership skills (ability to plan and lead) Fair Leadership skills (ability to plan and lead) Poor Leadership skills (ability to plan and lead) Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 8. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown Professionalism/Work ethic including dependability and reliability Professionalism/Work ethic including dependability and reliability Exceptional Professionalism/Work ethic including dependability and reliability Very Good Professionalism/Work ethic including dependability and reliability Good Professionalism/Work ethic including dependability and reliability Fair Professionalism/Work ethic including dependability and reliability Poor Professionalism/Work ethic including dependability and reliability Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 9. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown Ability to solve problems and offer thoughtful insights Ability to solve problems and offer thoughtful insights Exceptional Ability to solve problems and offer thoughtful insights Very Good Ability to solve problems and offer thoughtful insights Good Ability to solve problems and offer thoughtful insights Fair Ability to solve problems and offer thoughtful insights Poor Ability to solve problems and offer thoughtful insights Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 10. Please score applicant's: Exceptional Very Good Good Fair Poor Unknown Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Exceptional Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Very Good Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Good Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Fair Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Poor Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 11. Please score the applicant's : Exceptional Very Good Good Fair Poor Unknown Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Exceptional Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Very Good Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Good Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Fair Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Poor Interpersonal skills with children/youth, demonstrating the ability to engage appropriately Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 12. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Exceptional Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Very Good Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Good Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Fair Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Poor Interpersonal skills with adults, including the ability to receive feedback and respond to suggestions Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 13. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown Ability to work well as part of a team demonstrating listening and collaborating skills. Ability to work well as part of a team demonstrating listening and collaborating skills. Exceptional Ability to work well as part of a team demonstrating listening and collaborating skills. Very Good Ability to work well as part of a team demonstrating listening and collaborating skills. Good Ability to work well as part of a team demonstrating listening and collaborating skills. Fair Ability to work well as part of a team demonstrating listening and collaborating skills. Poor Ability to work well as part of a team demonstrating listening and collaborating skills. Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 14. Please score the applicant's: Exceptional Very Good Good Fair Poor Unknown English language competence - written and oral English language competence - written and oral Exceptional English language competence - written and oral Very Good English language competence - written and oral Good English language competence - written and oral Fair English language competence - written and oral Poor English language competence - written and oral Unknown Please include any comments that offer insights for the reasons for your ratings (above). Question Title * 15. Please comment on the applicant's motivation for teaching and any demonstrated strengths for working with children or youth. Question Title * 16. Please comment or elaborate on any areas where you have reservations concerning the applicant’s suitability for admission to a teacher education program. Question Title * 17. Overall recommendation Highly recommend Recommend Recommend with reservations Do not recommend Question Title * 18. Declaration: I declare that I am an eligible reference as outlined above and on the program websites, I am aged 18 or over, and that all the information I have provided is true and correct. I declare the applicant has not seen the completed reference form. Clicking "I Agree" indicates agreement to the above and as a signature on this reference form. I Agree Once you click DONE you will not be able to go back and make any edits to your answers Done
