Admissions

Reference Request

To:  The Applicant

Please complete this section of the form and pass it to the referees named on your application form requesting that it be completed and either returned to you or sent directly to us.

Surname/family name      -	

Cahyana

First/given name      	

11-07-1978

Date of birth

University of Birmingham ID number (if known)   	

Rail Systems Engineering and Integration (M.Sc. (Taught) Full-time)

Proposed programme of study   	

To: The Referee

Thank you for agreeing to write a reference for the above applicant.  Please write the reference in the space provided or submit it on official headed paper and attach to this form.  It would be helpful if you could include in your reference the following information:

•	Length of time and capacity in which you have known the applicant.

•	Applicant’s qualifications, level of performance and results (or expected results).

•	If possible, please indicate the applicant’s overall ranking in class compared to other students following the same degree programme.
•	Your assessment of the applicant’s potential or suitability to undertake the programme applied for.

•	The applicant’s motivation and intellectual capacity.

•	If the applicant is/was employed by your organisation, their duties and standard of work.

•	If the applicant’s first language is not English, whether you consider his/her ability to read, write, speak and comprehend English adequate for the programme applied for.
•	Any other information you think relevant and which you feel would assist the University in making its decision.

When you write a reference for an applicant, including those outside the UK, please remember that, under the Data Protection Act, the applicant can ask for a copy of the reference and any other information that we hold about them.

Please enclose this completed form together with your reference in a sealed envelope and sign it across the seal.  Return the envelope to the applicant or return directly to:

Admissions
University of Birmingham
Edgbaston Birmingham B15 2TT UK
Tel: + 44 (0)121 414 5488
Fax: + 44 (0)121 414 6378

Statement from Referee:

Admissions

Number of years that you have known the applicant:   	

In what capacity:   	

Please write your opinion on the academic ability of the applicant and suitability for the programme they have

applied for in the following space:

Name of Referee  	

Signature  	

Position held  	Date  	

Organisation/Institution Name and Address  	

Official stamp of institution or attach a business card

Telephone number:  	

Fax number