Form NM A-102

THE NELSON MANDELA

AFRICAN INSTITUTION OF SCIENCE AND TECHNOLOGY
(NM-AIST)

APPLICANTS REFERENCE FORM

PART A: TO BE FILLED BY THE APPLICANT
1. APPLICANTS PERSONAL INFORMATION (Tick appropriate box)
Title:

Mr

Mrs

Ms

Miss

Others
First Name:

Middle Name:

Surname:

Gender: Male

Female

Applicants Employer (If employed):

Immediate Supervisor:
Work Experiences in Years:

2: THE PROGRAMME APPLIED (Tick)

Masters

PhD

Programme

Specialization

Programmes

Specialization

Form NM A-102

PART B: TO BE FILLED BY THE REFEREE

1: REFEREE PERSONAL INFORMATION
Title: Mr

Mrs

Ms

Miss

Others
Full Name:
Occupation:
Phone Number:
Current Address:

E-mail:
District:

Region:

Employer:
2: APPLICATS ACADEMIC, PROFESSIONAL AND WORK ATTRIBUTES
(a) How long have you known the applicant?

(b) In what capacity have you known the applicant?

(c) What do you consider to be the applicants main academic strengths in relation
the course applied?

(d) How well do you think the applicant is prepared to pursue and complete post
graduate study?

Form NM A-102

(e) Give your comments on the applicants professional achievements in relation to

the programmes applied.

(f) What do you consider the applicants main academic weaknesses in relation to
the course applied?

(g) What is your opinion on the applicants suitability on the applied

programme?

(h) Please, evaluate the applicant with respect to each of the following
attributes:
S/
N
i.
1
ii.
2
iii.
3

ATTRIBUTE

EXCELLE
NT

Intellectual/academic
capacity
Oral communication
ability
Written communication
ability
Ability to work
iv.
4
independently
v. Perseverance
5
vi. Creativity in professional
6
work
vii. Records in professional
7
work
3

VERY
GOOD

GOO
D

AVERA
GE

NOT
ASSESSED

Form NM A-102
viii.
ix.
x.
xi.

8 Problems solving abilities

9 Mental Maturity
1
0
1
1

Motivation for
Postgraduate Studies
Ability to work with
others

(i) Is there any other information you feel is relevant for this applicant?

Date:

Referees signature: