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獨 輻
STUDENT FIRST NAM盈 ∠ じ 颯 5虚 轟 轟 進 名 ___…………――
一 】
を撻鑢゛藻河敷〉 i了 討FI(》 決

忍
耐磁鰍 青ざv輛鴛 摯 抒 霧 ゴ

TO STUDENTi Complete the inforlnnation atthe top ofthis form,Ask one of yOoFteaChers,who knOws y00 well′ to colllplete this for,l ryou c8綺 rlot
clloose a teacheL you tγ lay ciloose a scilool director or a teacller frorn a sc卜 o01 yoll recelltly atte1lded,This recolγ ドner〕 datior,ム ЛuST be filled()Llt iri Er)tllisI)
3,ld sont by yotir recolη rrlender directly to the AI,lerican councils olfice in your courltry`

lF T購 霊 緻ECOMMEND覆 資 KNOWS iF THE RttCOttMttND饉 鍮 00霊 S ttOT KNOW ttNttLiSH:

鷹NGLiSH: ・ Give hin1/11er the Elngiish For奮 14,tite local 18r19tlage Fori13 4
・ 6ive inlrn/her ONLY the Eng ish Forlln 4 ・ Ask tho recomlmelndertol
・ Ask the recommonderto fo1low the 、Complete t}le locallangtlage versloれ of Forll1 4.
directlons below ‐Have tt tra:lsiate(l or、 to tキ 、
e E1191lsh「 orrr1 4`TIIe tra,lsiator rTlust colγ lplete sectior,49
-Neitherthe app icant nOr a men3bcr ofthe appiicant s farnily「 nay transiate Form 4,
‐The roじ on3mende,s1lot,Icl solld both thc Ln91 sh and locallangat,9o lor'■ S directiy to tho
Amellcan Council、 offi()e ir〕 yot,r cOtifltry YotJ shotJld not see tlle re()()1綺 rnendation,

TO餃 饉COM翔 露翔D鷲 費:Your answers on this forrn wil be evaluated a on9 with the student's application to deter鮮 line his/her suitabiity for t}、 is

scholersI、 ip p100raF醤 `Iinereforeぃ ノ ″er eacl〕 part holnestly,carelに ￨lly ar、 d cornpletely`This forn〕 lllust be fllled out in Eng,lsh.The
e ask you to arls、
recominender shoold send the con,pletod recon3mendation(and iOC811angu3ge version iFtranslated)direCtly to the Annettcan Oouncils orlice in your
country,Tlne student shotlld oot see the cornpleted recommendation forlnn.

4.電 Please describe tllis student's behavlor Ho、 ″does the stllclont respond to authrlrity?Hov′ doos he/she relate to peers and rlarticipate in g:oup
prOleCtS Wtth other studerits?What talents,interests and skilis dces this student i、 ave that wili contabute to an internatlonal exchange exper encc?
Please gi,re exarnples"
α,α ttι ″ら
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ι為 え/ 勧艇九ι
ι %`ぇ s ″
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3ご

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4.? Please comment on ihe student's motivation in school and study habiis. ゴ′
′ι乏
″θνtt ι
ι″ a
α3ム ″じ″ ″ン
ι ノ
` `ノ
ノα

4.3 Please evaluate the stildent's character in the {ollolving cateqories (check ihe appropriate boxes):
Personality Traits Excellent Above Average Average
撚瀾Ul ry l墨:磁熱斯務鐵轟轟Ⅲ‖ l:灘 華:二 ￨=:
‖薦 ,1,:二 :轟 二1轟 轟轟酬‖出耀場ダ 謝鰊 ‖鵬脚1鰈
0penness U U
iiiiersrrip 'i,t ',' @ il ,■‖,■ ・
i● 1111:
Ability to adapt to new situations
':" ,
*Abilitllrxo irlferact with otheii
B tr 腱 =ヽ □
@ tl ￨1嘩 :=111 ￨￨￨￨IⅢ III11111111
園 級
1薦議 llC・ ibllty lll:卦 !‖ ‖‖I=■ ≡饉■￨= ■11議 ■1職 ■:=■ 1■ ￨￨ぼ ■■￨==:￨
Respect for others 9 =■ 職
い1幕燿霧 ￨=書毒華:毒 譲議‖I￨ド華ド￨￨1斎
:十 ■:難■
=■
■■義￨■
cunO麟 ty . 繊 軸 嚇 職 =■ =￨
轟還魏断計
‖i』 ‖
蝋絆麟ownI I=■ 鑽 ￨■￨￨￨￨￨￨￨■1義 ￨
￨■ 醸 ￨■ ￨￨￨￨￨￨ ■ ￨￨￨1轟 ￨￨￨￨￨￨￨11■
Commentsr
=■

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繊蟻懺意ヽ遊゛黛譲
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ま
ヽ紫ぐ申卜:剌 灘》
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詳勁ば,!→ T瀬 ユ哺鏑墓戦

STり DENT FIRST NAME: α″″`ん

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4.導 a, Has the student had any adiustment Or disciplinary problems at schoo? こ YES
1ま 鴫 NO
4,4わ 、lias the student missed or ttpeattd a year? 磯 YES 臓 NO
4,4c. Ooes the student have a history of continuoos orfreque,lt absences froln sc1lool? 磯YES
こ □ NO
4.4d. Does the sttident currently have any special educatlonai needs? Ett YES 職 NO
Fo″ e給 制ρれ θre ぉθびルο ce′ ′
1/1ey eκ θ/71ε わssas′ cJl′ ″eχ ル ″eO″ θsso′ 劇θ
θ ″お′
Or Or17θ r Sわ ,1/a′ ′ε
ε 7'脅 OdarFO/7s. “
ο′ `″

lf yoLr answered "yesi" t0 any question, please explain:

４
５

Hor,v long have you known this student? Years:

導
６

ln urhat conlext do you know this student? .

"i
l
４
７

Are you a teacher at the student's high school? ffi vfS 機 NO「 no′ explainl

4.8 Check one of the following and explain below:

[l t teel this applicant is ready to become an exchange sludent,

f t have snrne reservations ab0ill this applicant's reariiness to become an exchango student,

f t rio not recommend this applicant.

Please explain; ど物′

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驀籐義 歯 11彙 藝 :轄 ■■■■￨■■ ■￨￨■ ■■￨■

4,9 This section nlust be filled out by the trarlslator ifthe original recomlnendation is ootin Engiish.

I hereby “
certify that lhe above English lranslation is a and acctrate rettdering of the origitlai text.

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