Education Qualifications Emailable Reference Form

The purpose of this report is to receive comment about the applicant to assess their suitability for teaching children against the New Zealand Education Council 'Good Character and Fit to be a Teacher' criteria. The information you provide is confidential to Open Polytechnic and will not be shared with the applicant.

Please complete all relevant sections of this report, and indicate the applicant's level of personal skills and attributes as part of your overall recommendation.
Please note: we require students to provide at least one reference who has observed them working with tamariki.

If you have any reservations regarding the applicant's suitability, or any other information that you consider would help us make a decision about the applicant, please inform the Student Advisor by email or freephone 0508 650 200.

Thanks for taking the time to be a referee, any information you give us will be kept in confidence.

Please complete and submit this form as soon as possible. We cannot process the potential student’s application until we receive this reference.

Relationship with applicant

Referee criteria

Please note we cannot accept references from friends or family members. Please confirm your relationship to the referrer below:


Unfortunately we cannot accept references from friends or family members. Please fill out this alternative form so we can notify the applicant. Thank you.

During what period have you known the applicant?

Skills and attributes of applicant

Please comment on your observations of the applicant interacting with the following people:

(Please comment in which capacity the observation was made, and detail the applicant's interaction skills)

How would you rate the applicant in the following areas?

Support your rating with comments and examples. 

(Tick the ‘Not observed’ box if you have not had the opportunity to observe the applicant demonstrate any of the following).

Sensitivity and compassion
Respect for others
Imagination, enthusiasm and dedication
Communication skills (oral, speaking and listening)
Communication skills (written)
Physical and/or mental capacity (to meet the demands of teaching)
Cultural Competency (ability to interact with, be respectful and responsive to people whose cultures are different form their own)
Do you consider that the applicant has a suitable level of reading ability, has clear and articulate writing.

Overall recommendation

Do not complete this recommendation until you have answered all other questions on this form.

Acknowledgement of true information

Please tick this box to confirm that all information presented in this reference is true, complete and accurate.

Please tick the box to acknowledge you understand that this information will be used by Open Polytechnic to assess the applicant’s eligibility for admission into the  Graduate Diploma in Teaching.

Thank you for completing this form

Please select SUBMIT to complete the form.

We may wish to contact you to discuss your appraisal of the applicant. In the meantime, if you would like to contact us you can call freephone 0508 650 200.