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Application - Brandon University

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					                               BRANDON UNIVERSITY

                          FACULTY OF EDUCATION




                        Admission Information for 2011


                        Bachelor of Education (After Degree)


                        A 2-year certification program for teachers of

                        Early Years (K-Grade 4)
                        Middle Years (Grades 5 – 8)
                        Senior Years (Grades 9 – 12)
Additional Admission
Inquiries:
Faculty of Education
 (727-9626)
facultyed@brandonu.ca

Admissions Committee
Faculty of Education
Brandon University
        th
270 - 18 Street
Brandon, MB R7A 6A9
                                                                                               1

                                  Table of Contents

Information for Applicants                                                                               2


   1.   Application Deadline and Important Dates                                                         3


   2.   Documentation                                                                                    3


   3.   Application Fee                                                                                  4


   4.   Selection Process                                                                                4


   5.   Academic Requirements for Admission                                                              5


        a.   General Academic Preparation for Early and Middle Years Applicants                          5


        b.   Early and Middle Years Routes                                                               5


        c.   Senior Years Route                                                                          6


   6. Application Checklist                                                                              7


Early OR Middle Years Application for Admission                                                          8


Senior Years Application for Admission                                                                  11


Reference Form                                                                                          14




Note: A Manitoba Teacher’s Certificate can only be awarded to those with Canadian Citizenship, Landed
Immigrant status, or a Work Visa for Canada.
                                                                                                            2




                                     Information for Applicants
                         to the Bachelor of Education After-Degree program
                                       at Brandon University


Students applying to the Bachelor of Education After-Degree Program must have successfully completed an
undergraduate degree. The degree must include coursework as outlined below.

To qualify as a Senior Years teacher an applicant must have a 30 credit hour major in a teachable subject and an
18 credit hour minor in a second teachable subject.

To qualify as an Early Years (K – Grade 4) OR Middle Years (Grades 5 – 8) teacher, an applicant must have 18
credit hours of coursework in one teachable subject and 12 credit hours of coursework in a second teachable
subject. If not included in the teachable subject areas, the following subjects must have been successfully
completed: 6 credit hours in English or French literature, 6 credit hours in history and/or geography, and 9 credit
hours in a combination of mathematics and science (i.e. 3 credit hours of mathematics and 6 credit hours of
science, or 3 credit hours of science and 6 credit hours of mathematics). To satisfy the science requirement, the
applicant must have successfully completed courses in the Departments of Biology, Botany, Chemistry, Geology,
Physics, or Zoology. In exceptional circumstances, students who have incomplete academic qualifications up to 6
cr. hrs. may be admitted to the B.Ed. program. Teacher education candidates will be recommended for certification
only when all program and certification requirements have been met.

The Professional Certification and Student Records Unit of Manitoba Education recognizes many major and minor
subject areas including:
Art, Biology, Business Education, Chemistry, Computer Science, English, French, Geography,
Heritage/Aboriginal/World Language, Human Ecology, History, Industrial Arts, Mathematics, Music, Physical
Education, Physics, Theatre and Vocational Industrial. While this list includes all the subjects certified by the
Province, the Faculty of Education at Brandon University currently offers methods courses only in those subjects in
bold.

Admission is highly competitive. Applicants will be screened first for satisfying academic certification requirements.
Only applicants with a grade point average (GPA) of 2.5 or greater will be considered. Teachable subjects in
greater demand by employers may receive preferential consideration. Applications submitted by February 15,
2011 will be given first consideration. Applications submitted promptly and completely will give candidates a
better chance for admission into the program.

Candidates will be evaluated on the following: courses and marks, cover letter, résumé, teachable subjects and
residency. Selected candidates may be invited for an interview.

A candidate who intends to apply to more than one route (Early, Middle, Senior Years) must meet the
requirements and submit a completed application for each stream.
                                                                                                          3

1. Application Deadline and Dates
Applications submitted by February 15, 2011 will be given first consideration. All required forms must be received
by the Faculty of Education Admissions Committee before the application can be considered.

Letters of Conditional Acceptance may be sent as early as May 2011.

 An interim transcript is required to be submitted with the application by February 15, 2011. Final transcript
confirming graduation is required by June 15, 2011. Applications will not be considered after this date.

The student must make arrangements to have an official transcript sent to the Admissions Committee. The final
transcript must include the notation of conferral of the degree.

For the application to be considered complete, the applicant must provide the Faculty of Education with an original
and current Child Abuse Registry Check and Criminal Record Check along with the application.
            .

2. Documentation

   Materials submitted as part of the application for admission to the Faculty of Education become the property of
    Brandon University and will not be returned to the student. Items to be submitted include:

    o The Brandon University Application for Admission Form must be submitted by students who have
      never attended Brandon University,

    o The Brandon University Faculty of Education Application for Admission Form appropriate for the
      teaching level (early, middle or senior years),

    o A Cover Letter and Personal Résumé outlining non-credit coursework, certificates, a list of 3 referees with
      their contact information, your work and/or volunteer experiences with individuals or groups with particular
      emphasis on your experiences in an educational or other learning environment, and

    o Three Letters of Reference using the attached form must be enclosed with the application (professor or
      professional/principal or teacher/personal). Referees cannot be friends, family members or relatives.

    o Each applicant must submit a current, original Child Abuse Registry Check and Criminal Record Check.
      The Child Abuse Registry Check application form can be found online
      at:http://www.gov.mb.ca/fs/childfam/child_abuse_registry_form.html. The Criminal Record Check
      form is available from your local police force office. Students are advised to retain four copies of the
      original Child Abuse Registry Check and Criminal Record Check as they are required for each student
      teaching placement.

    o Graduates from Universities other than Brandon University must submit an Official Transcript including
      notation of conferral of the degree. It must be received by the Admissions Committee on or before June
      15, 2011.

   An applicant who declines an offer of admission and subsequently wishes to enter the program must reapply
    by submitting all appropriate forms and documents.

   Incomplete applications will be removed from the application pool at the deadline date. The Application Fee
    will not be returned to the applicant.
                                                                                                        4
3. Fees

       Brandon University Application Fees

        An applicant who is being admitted to Brandon University for the first time must submit an application
        fee. This fee must be paid before the Application for Admission to Brandon University will be processed.
        The Application Fee is non-refundable. The Application Fee for a Canadian applicant is $60. A student
        who has already been admitted to Brandon University is not required to submit the Application Fee.

       Faculty of Education Application Fee

        There is a $75 fee which must accompany the application. If a student wishes to apply into more than
        one route, ie. Early Years and Middle Years, only one application fee is to be submitted.

4. Selection Process
   Note: (EY = Early Years; MY = Middle Years; SY = Senior Years)

   The selection process varies slightly from Early to Middle to Senior Years. The variation accounts for the
   depth and breadth of knowledge that teachers at each level require. For example, teachers at the Early/Middle
   Years level require great breadth in their knowledge base as they typically teach a broad range of subjects.
   Teachers in Senior Years typically teach one or two subjects and, therefore, require greater depth in specific
   subjects. During the selection process, the Admissions Committee of the Faculty of Education reviews each
   application and assigns a value to each of the following:

   a)   Grade Point Average (EY; MY; SY) – the applicant’s capacity to learn is significant in the selection
        process. When an applicant has taken additional course work to improve academic standing, the new
        course grades will be factored into the grade point average score.

   b)   Cover Letter and Résumé (EY; MY; SY) – each applicant is required to submit a typed cover letter and
        personal resumé outlining non-credit coursework, certificates, list of 3 referees with their contact
        information, and work and/or volunteer experiences with individuals or groups with particular emphasis on
        experiences in an educational or other learning environment.

   c)   Teachable Subjects (MY; SY) – the demand for teachers in certain subjects evolves each year. In an
        effort to meet the demand, the Admissions Committee consults with Manitoba superintendents to identify
        those areas where teachers are in the greatest demand. Teachable subjects with the greatest demand
        will be given a higher weighting in the selection process than those subjects with lower demand.

   d)   Residency (EY; MY; SY) – Brandon University attempts to serve its qualified graduates first. However,
        Brandon University welcomes applicants who have graduated from other institutions.

   e)   Letters of Reference (EY; MY; SY) – Each applicant is required to provide three letters of reference using
        the attached form. An applicant is encouraged to have a letter of reference from a professor, a school
        principal, a teacher or other professional. Referees cannot be friends, family members or relatives.

   f)   Teaching Placements: The applicant’s willingness to complete at least two student teaching placements
        outside Brandon will be considered.

   g)   Interview (EY; MY; SY) – After applications are evaluated on the above criteria, an applicant may be
        invited for an interview at Brandon University.
                                                                                                             5
5.      Academic Requirements for Admission
A.   General Academic Preparation for Early and Middle Years Applicants

     The Professional Certification & Student Records Unit of Manitoba Education requires that individuals seeking
     certification in the province of Manitoba as Early or Middle Years teachers have, as part of their university
     studies, 6 credit hours of English Literature or French Literature, 6 credit hours of history or geography, and 9
     credit hours in a combination of mathematics and science. Students planning to graduate from Brandon
     University will select these 21 credit hours from the following approved lists of courses:

        English Literature –6 credit hours:                         Geography / History - 6 credit hours:
          all English courses listed in the English                    any course listed in the History or Geography
          Department of the current Brandon                            Department at Brandon University.
          University calendar with the exception
          of 30.090 and 30.150

        French Literature –6 credit hours:                          Science – 3 or 6 credit hours from:
           any Brandon University course from                          14/94:162 Biology I
           58:FREN.275 and above.                                      14/94:163 Biology II
                                                                       18:160 General Chemistry I
        Mathematics – 3 or 6 credit hours from:                        18:170 General Chemistry II
          62:150 Mathematics 100                                       42:160/161/162/163 (Geology)
          62:152 Contemporary Mathematics                              74:132 General Physics
          62:155 Mathematics of Finance                                74:184/185 (Physics & Astronomy)
          62:171 Introduction to Statistics                            94:132 Human Anatomy & Physiology
          62:181 Calculus I                                            or other courses in, Botany, Chemistry,
          62:191 Calculus II                                           Geology, Physics or Zoology departments at
          62:182 Introduction to Linear Algebra                        Brandon University.
          or other Brandon University mathematics
          courses selected from Groups A or B.



        Students from other universities are advised to check the Brandon University calendar website for
        equivalent or similar courses.

B.   Early and Middle Years Routes

     In addition to satisfying the requirements in Section 5A the applicant must have an 18 credit hour FIRST
     teachable subject and a 12 credit hour SECOND teachable subject. Teachable subjects for Early and Middle
     Years for which we offer methods courses are indicated in bold:

     a) 18 credit hour FIRST Teachable must be selected from the following list:

        Art                                   Geography                              Music
        Biology (Botany/Zoology)              Heritage/Aboriginal/World              Native Studies
        Business Education                       Language                            Physical Education
        Chemistry                             History                                Physics
        Computer Science                      Human Ecology                          Theatre
        English                               Industrial Arts                        Vocational Industrial
        French                                Mathematics


     b) 12 credit hour SECOND Teachable must be selected from the following list:

        Anthropology                                  Chemistry                      Developmental Studies
        Art                                           Classics                       Earth Science
        Biology (Botany/Zoology)                      Computer Science               Economics
        Business Education                            Dance                          English
                                                                                                           6
        Environmental Studies              Industrial Arts                         Physics
        French                             Law                                     Political Science
        Geography                          Mathematics                             Psychology
        Heritage/Aboriginal/World          Music                                   Sociology
        Language                           Native Studies                          Theatre
        History                            Philosophy                              Vocational Industrial
        Human Ecology                      Physical Education



C.   Senior Years Route

     An applicant must have a 30 credit hour major and an 18 credit hour minor in teachable subjects for Senior
     Years. Teachable subjects for Senior Years for which we offer methods courses are indicated in bold:


     a) 30 credit hour FIRST Teachable must be selected from the following list:

        Art                                 Geography                              Music
        Biology (Botany/Zoology)            Heritage/Aboriginal/World              Native Studies
        Business Education                     Language                            Physical Education
        Chemistry                           History                                Physics
        Computer Science                    Human Ecology                          Theatre
        English                             Industrial Arts                        Vocational Industrial
        French                              Mathematics


     b) 18 credit hour SECOND Teachable must be selected from the following list:

        Anthropology                               English                         Heritage/World/Aboriginal
        Art                                        Environmental Studies           Languages
        Biology (Botany/Zoology)                   French                          Native Studies
        Business Education                         Geography                       Philosophy
        Chemistry                                  History                         Physical Education
        Classics                                   Human Ecology                   Physics
        Computer Science                           Industrial Arts                 Political Science
        Dance                                      Law                             Psychology
        Developmental Studies                      Mathematics                     Sociology
        Earth Science                              Music                           Theatre
        Economics                                                                  Vocational Industrial




6. Application Forms

A.   Brandon University Application form

     This application form must be completed and submitted by an applicant who has never been admitted to
     Brandon University. The applicant should include the appropriate application fee – $60 for a Canadian
     applicant. You may access an application form to apply on line or to print the application form at
     https://webapp.brandonu.ca/pls/admission/f?p=114:1.
                                                                                                         7




                                             Brandon University
                                            Faculty of Education
                                      APPLICATION CHECKLIST
This checklist will assist you with the application process. Keep this checklist for your information.


REMINDER:
    The review of completed applications will begin February 15, 2011. Applications received by this date will
      be given first consideration.
    All required forms and fees must be received by the Brandon University Admissions Office and the
      Faculty of Education Admissions Committee before the application can be considered.
    Official, final transcripts must be received by June 15, 2011.


1. Application for Admission to Brandon University - for students who did not attend Brandon University.
Complete the online application: https://webapp.brandonu.ca/pls/admission/f?p=114:1.

2. Application Form for Admission to the Faculty of Education of Brandon University including:

       a   Cover Letter and Personal Resumé outlining your work and/or volunteer experiences with particular
            emphasis on your experiences in an educational or other teaching setting.

       b   Three Letters of Reference (a professor, a school principal, a teacher or other professional).
            Referees cannot be friends, family members or relatives. The attached letter of reference form must
            be used.

       c   Official Transcript MUST include the date and name of the degree awarded with final grades. (a
            photocopy is unacceptable) Graduates of Brandon University do not need to submit an official
            transcript.

       d   Criminal Record Check The current, original document must be received by Brandon University with
            the application. An applicant is advised to retain a copy of the original Criminal Record Check
            result as it is required for each student teaching placement.

       e   Child Abuse Registry Check. The current, original document must be received by Brandon
            University with the application. An applicant is advised to retain a copy of the original Child
            Abuse Registry Check result as it is required for each student teaching placement.
            Send these items to:                        Admissions Committee
                                                        Faculty of Education
                                                        Brandon University
                                                                 th
                                                        270 – 18 Street
                                                        Brandon, MB R7A 6A9
                                                                                                                    8




                                               FACULTY OF EDUCATION

                                          APPLICATION FOR ADMISSION
                                           Bachelor of Education, After Degree

          EARLY YEARS                                                   MIDDLE YEARS
                                                                                                               st
If you are applying for more than one stream indicate your preferred route(s) [1, 2, 3] 1 being your 1 choice, etc.
PREREQUISITE: B.A., B.Sc., B.G.S., B.Mus, or other equivalent university degree.

Applications received by February 15, 2011 will be given first consideration. Application fee of $75 must
accompany the application.

Transcripts: Official transcript(s) showing conferral of degree must be received by June 15, 2011.


NAME: ____________________________/________________________________________________________
                   (Surname / Given Names as shown on your Birth Certificate – use FULL names only)

MAILING ADDRESS:             ________________________________________________________________________
                                   (Box # or Street #)                    (City /Town)                     (Province)

__________ TELEPHONE NUMBER: (_______)________ Email Address:______________________________
(Postal Code)                                    (Area code) (Number)

PREREQUISITE DEGREE: __________________                          GRANTING INSTITUTION: ___________________

DEGREE G.P.A.: _________________                                 DATE CONFERRED: ________________________
(Based on courses taken to date)

B.U. Student Number: ____________________ (required)

NOTE: Admission to this program is competitive and individuals who meet the minimum requirements
may not be selected. A candidate who intends to apply to more than one route (Early, Middle, Senior
Years) must meet the requirements and submit a completed application (see the Application Checklist) for
each route.

  For office use only       Requisite courses:                                      Teachable Subject Areas:
                                                                                    1                      2
  REGULAR:                  English/French                        Resumé
                            History/Geography                     Transcript
  LATE:                     Mathematics                           CARC
                            Science                               CRC               References:




Early OR Middle Years Application Form Page 1
                                                                                                            9


Admission to the Bachelor of Education program is competitive. It is based upon the following criteria:
    Completion of this form in its entirety including required documents. Incomplete applications will not be
      considered.
    A completed degree. The student is expected to have completed a first degree. An official transcript
      identifying the student’s degree must be received by Brandon University on or before June 15, 2011.
    Academic coursework completed and the teachable subject areas within the first degree.
    The degree grade point average (G.P.A.).
    The cover letter and depth and breadth of the student’s résumé.
    The student’s place of residence and/or university granting the first degree.
    A satisfactory Child Abuse Registry (C.A.R.) Check and Criminal Record (C.R.) Check.
    The student’s willingness to complete at least two student teaching placements outside Brandon.

Students may be required to attend an interview.

Exceptional Circumstances:

In addition to your résumé, you may wish to identify any exceptional circumstances which you feel should be
considered during the review of your application. This could include additional courses being taken or personal
circumstances relative to your experience, training or suitability for the teaching profession. Please attach any such
explanation to your résumé when you apply.

General Academic Preparation:

         See Sections 5 A. and B. of the Information for Applicants document.

Below, please list the courses (including the course number, course name and credit hour value) that
satisfy the minimum requirements for certification (e.g. 94:162 Biology I, 3 cr. hr. in the space provided:)

                                                   Course No.              Course Name                       Cr. Hrs.
1. English or French Literature (6 cr. hr.)   1.

                                              2.

2. Mathematics (3 - 6 cr. hr.)                1.

                                              2.

3. Science (3 - 6 cr. hr.)                    1.

                                              2.

4. History or Geography (6 cr. hr.)           1.

                                              2.



Early OR Middle Years Application Form Page 2
                                                                                                                10
Academic Preparation:

In the columns below, please list the courses (including the course number, course name and credit hour value)
that make up the 18 credit hour FIRST and 12 credit hour SECOND teachable subjects.


A.   18 Credit Hour FIRST Teachable subject is:           B. 12 Credit Hour Second Teachable subject is:
     ______________________________________                  ___________________________________________

     e.g. 30.140 Intro to Modern Literature (6 cr. hr.)           e.g. 30.140 Intro to Modern Literature (6 cr. hr.)


     Course No.          Course Name               Cr. Hrs.       Course No.           Course Name                Cr. Hrs.
1                                                             1

2                                                             2

3                                                             3

4                                                             4

5

6




Placements:

Identify two (2) schools or school divisions, other than the Brandon School Division, in which you are prepared
to participate in Field Experience placements:

1. _____________________________________                  2. ____________________________________


Certification.

I hereby apply for admission to the Faculty of Education at Brandon University and accept the conditions of
admission as outlined in the regulations of Brandon University and the Faculty of Education. I certify that the
information entered on this application is complete and accurate.

I understand that if I incur any charges after my Criminal Record Check has been submitted with my application, or
if my Criminal Record Check indicates pending charges, I will fully disclose to the Director of Field Experience the
nature of the charges. Failure to do so can result in immediate dismissal from the program.

Date: ________________________            Signature: __________________________________________

Enclose all materials as indicated on the Application Checklist.


Early OR Middle Years Application Form Page 3
                                                                                                                    11




                                               FACULTY OF EDUCATION
                                          APPLICATION FOR ADMISSION

                                         Bachelor of Education, After Degree

                                                         SENIOR YEARS
                                                                                                               st
If you are applying for more than one stream indicate your preferred route(s) [1, 2, 3] 1 being your 1 choice, etc.
PREREQUISITE: B.A., B.Sc., B.G.S., B.Mus, or other equivalent university degree.

Applications received by February 15, 2011 will be given first consideration. Application fee of $75 must
accompany the application.

Transcripts: Official transcript(s) showing conferral of degree must be received by June 15, 2011.

NAME: ____________________________/________________________________________________________
                   (Surname / Given Names as shown on your Birth Certificate – use FULL names only)

MAILING ADDRESS:             ________________________________________________________________________
                                   (Box # or Street #)                    (City/ Town)                     (Province)

__________ TELEPHONE NUMBER: (_______)________ Email Address:______________________________
(Postal Code)                                    (Area code) (Number)

PREREQUISITE DEGREE: __________________                          GRANTING INSTITUTION: ___________________

DEGREE G.P.A.: _________________                                 DATE CONFERRED: ________________________
(Based on courses taken to date)

B.U. Student Number: ____________________ (required)

NOTE: Admission to this program is competitive and individuals who meet the minimum requirements
may not be selected. A candidate who intends to apply to more than one route (Early, Middle, Senior
Years) must meet the requirements and submit a completed application (see the Application Checklist) for
each route.

 For office use only        Requisite courses:                                      Teachable Subject Areas:
                                                                                    1                      2
 REGULAR:                   English/French                        Resumé
                            History/Geography                     Transcript
 LATE:                      Mathematics                           CARC
                            Science                               CRC               References:



Senior Years Application Form Page 1
                                                                                                            12

Admission to the Bachelor of Education program is competitive. It is based upon the following criteria:
    Completion of this form in its entirety including required documents. Incomplete applications will not be
      considered.
    A completed degree. The student is expected to have completed a first degree. An official transcript
      identifying the student’s degree must be received by Brandon University on or before June 15, 2011.
    Academic coursework completed and the teachable subject areas within the first degree.
    The degree grade point average (G.P.A.).
    The cover letter and depth and breadth of the student’s résumé.
    The student’s place of residence and/or university granting the first degree.
    A satisfactory Child Abuse Registry (C.A.R.) Check and Criminal Record (C.R.) Check.
    The student’s willingness to complete at least two student teaching placements outside Brandon.

Students may be required to attend an interview.

Exceptional Circumstances:

In addition to your résumé, you may wish to identify any exceptional circumstances which you feel should be
considered during the review of your application. This could include additional courses being taken or personal
circumstances relative to your experience, training or suitability for the teaching profession. Please attach any such
explanation to your résumé when you apply.

Academic Preparation:

In the columns below, please list the courses (including the course number, course name and credit hour value)
that make up the 30 credit hour FIRST and 18 credit hour SECOND teachable subjects.


A.   30 Credit Hour FIRST Teachable subject is:           B. 18 Credit Hour Second Teachable subject is:
     ______________________________________                  ___________________________________________

     e.g. 30.140 Intro to Modern Literature (6 cr. hr.)       e.g. 30.140 Intro to Modern Literature (6 cr. hr.)


     Course No.          Course Name      Cr. Hrs.    Course No.            Course Name          Cr. Hrs.
1                                                    1

2                                                    2

3                                                    3

4                                                    4

5                                                    5

6                                                    6

7

8

9

10



Senior Years Application Form Page 2
Placements:

Identify two (2) schools or school divisions, other than the Brandon School Division, in which you are prepared to
participate in Field Experience placements:

1. _____________________________________                  2. ____________________________________


Certification:

I hereby apply for admission to the Faculty of Education at Brandon University and accept the conditions of admission as
outlined in the regulations of Brandon University and the Faculty of Education. I certify that the information entered on this
application is complete and accurate.

I understand that if I incur any charges after my Criminal Record Check has been submitted with my application, or if my
Criminal Record Check indicates pending charges, I will fully disclose to the Director of Field Experience the nature of the
charges. Failure to do so can result in immediate dismissal from the program.


Date: ________________________            Signature: ___________________________________________




Enclose all materials as indicated on the Application Checklist.
Senior Years Application Form Page 3
                                            Faculty of Education
                                               Reference Form
                                    IN SUPPORT OF APPLICATION TO THE
                                          FACULTY OF EDUCATION



Applicant’s Name_________________________________________                     Date:______________________


REFEREE INFORMATION: (Please Print) Name __________________________________________________

Occupation/Position_________________________ Phone Number _______________________________

Address: _______________________________________________________________________________

Number of years you have known the candidate: ________
Relationship to candidate, i.e., supervision, colleague, employer, teachers, etc.
________________________________________________________________________________________

Please complete the following chart by placing check marks in the appropriate box rating his/her suitability
for teaching.

      SKILLS         OUTSTANDING                 GOOD                      FAIR             POOR
Cooperation
Communication
Energy
Enthusiasm
Flexibility
Humour
Initiative
Leadership
Organization
Responsibility
Sociability
Tolerance
Problem Solving
Team Player

In your estimation, how would you rate this candidate’s potential as a teacher?

       Exceptional                     Above average                              Average


Additional comments you would like to offer:
_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

Signature:    ___________________________________________________________________________

Please return your reference form to the candidate in a sealed envelope.