Honours ProgramAcademic Referee Form

The applicant is to complete Section 1 of the form and forward it to the relevant Academic Referee to complete the remainder of the form. The applicant is responsible for ensuring that the nominated person has agreed to be listed as a referee.The applicant is required to submit two(2) completed academic referee forms in total from 2 different referees, along with the other documents required to apply for the Honours program.If you can no longer find a suitable academic referee, you may wish to ask a current or previous employer to complete the referee form.

Please note that the academic referee cannot be a potential supervisor.

All documentation must be submitted as a completed application pack to the Postgraduate Research Coordinator at .

  1. PERSONAL DETAILS (to be completed by the applicant)

Title / Given Name / Family Name
Email / Phone Number
Qualification / Year of completion
Institution

2.REFEREE REPORT (to be completed by the referee)

Title / Given Name / Family Name
Email / Phone Number
Position / Department
Institution

a)For what time period have you known the applicant?

During undergraduate studies:☐3-6 months ☐6-12 months ☐1-2 years ☐2 years+

During postgraduate studies:☐3-6 months ☐6-12 months ☐1-2 years ☐2 years+

Other, please specify:Click here to enter text.

b)In what capacities have you known the applicant?

  • Coursework Lecturer ☐
  • Head of Department/Institution ☐
  • Clinical Supervisor ☐
  • Postgraduate degree supervisor ☐
  • Other, please specify: Click here to enter text.

c)Please rate the applicant in comparison to other students who you have supervised and/or taught:

Top 5% ☐ Top 10% ☐ Top 15% ☐ Top 20% ☐Top 25% ☐

d)Please score the applicant on a scale of 1-10 (10 being the highest)

Creative Ability: ability to develop original ideas or approaches without prompting Choose an item.

Initiative: ability to embark on new ideas or approaches without promptingChoose an item.

Motivation: ability to complete a research degreeChoose an item.

Planning: ability to keep to a scheduleChoose an item.

Perseverance: ability to work in difficult circumstancesChoose an item.

Critical Ability: ability to appraise and analyse information and argumentsChoose an item.

Communication: oral and written skills in field of studyChoose an item.

e)How would you assess the applicant’s research potential based on their academic records and your knowledge of the applicant?

Click here to enter text.

f) Please add any additional comments that you think are relevant to the application.

Click here to enter text.

3.DECLARATION(to be completed by the referee)

  1. I declare that all information on this Academic Referee Form is correct and complete and that I am qualified to comment on the applicant’s academic skills and experience.
  1. I have understand that the applicant is applying to enroll in a research qualification and have provided answers above to the best of my knowledge around their capacity to undertake such a qualification. I also understand that the College reserves the right to seek verification of theinformation supplied by me.

Signature / Date

OFFICE USE ONLY

Date Received
Applicant Notified /  Filed / Reviewed by Honours Degree Coordinator
Approved / Denied / Signature / Date

Australian College of Natural Medicine Pty Ltd (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation

Honours Program Academic Referee Form - F-139 / Effective Date:11-Dec-15
Version:5.0 / Page 1