Confidential reference submission form

Thank you for completing this confidential reference form for the 4-year Elementary Curriculum program. 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, 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 31

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* 1. Applicant Information

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* 2. Which program is the applicant applying for?

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* 3. Which program location is the applicant applying for?

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* 4. Reference Information (your information)

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* 5. Please describe your relationship to the applicant, and the context in which you observed them working with children/youth.

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* 6. In what role and during what time period did you observe the applicant engaged with children/youth?

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* 7. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
Leadership skills (ability to plan and lead)

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* 8. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
Professionalism/Work ethic including dependability and reliability

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* 9. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
Ability to solve problems and offer thoughtful insights

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* 10. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
Adaptability/flexibility to changing circumstances and/or ability to cope with stressful situations

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* 11. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
Interpersonal skills with children/youth, demonstrating the ability to engage appropriately

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* 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

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* 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.

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* 14. Please score the applicant's:

  Exceptional Very Good Good Fair Poor Unknown
English language competence - written and oral

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* 15. Please comment on the applicant's motivation for teaching and any demonstrated strengths for working with children or youth.

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* 16. Please comment or elaborate on any areas where you have reservations concerning the applicant’s suitability for admission to a teacher education program.

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* 17. Overall recommendation

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* 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.

Once you click DONE you will not be able to go back and make any edits to your answers

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