After completion of the first section of this form, kindly send it to your referee with the request that he/she complete the second section and return it to us BEFORE 25 May 2012 which is the closing date. Late applications will not be considered. No emails or Fax copies will be accepted. |
First Section
Name of Referee: ______________________________________________________________________________
Position / Profession: ____________________________________________________________________________
Address: _____________________________________________________________________________________
Telephone no: _________________________________________________________________________________
Email address: _________________________________________________________________________________
Applicant's name:
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Second Section (To be filled in by referee)
Dear Referee
Would you kindly respond to the questions below, bearing in mind the applicant's suitability for training in Clinical Psychology. Your comments are strictly confidential and will not be divulged to the applicant. Referee reports often tend to be uncritically positive - you are encouraged to pay attention to both the applicant's strengths and limitations as you perceive these, when completing the form.
1. For how long and in what capacity, have you known the applicant?
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2. Do you consider the applicant to be:
very suitable ..................................................................................................................
adequate .......................................................................................................................
unsuitable ......................................................................................................................
for training in Clinical Psychology?
3.Please motivate your opinion expressed in (2)
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4. How would you rate his/her ability/potential in the following areas? Please mark the appropriate column.
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Academic Ability |
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Writing Ability |
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Research skills |
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Warmth |
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Self-Assertiveness |
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Emotional Stability |
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Reliability |
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Independence |
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Initiative |
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Verbal Ability |
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Likeability |
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Maturity |
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Ability to cope under pressure |
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Regard and Respect for others |
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Intelligence |
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Emotional availability |
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Overall Clinical Potential:
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Additional comments would be appreciated, including any reservations you may have concerning the candidate:
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Signature ...........................................................
Date ....................................................................
PLEASE MARK ENVELOPE "CONFIDENTIAL REFEREE'S REPORT" AND SEND
TO:
The Director
University of Cape Town
Child Guidance Clinic
Chapel Street
Rosebank
7700
Telephone no: (021) 650 3900