2049 NW Hoyt Street, Portland, Oregon 97209
503-223-8188 · Fax: 503-227-7003 ·

Self-Guided Advanced Studies Reference Form

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(NAME OF APPLICANT)

This form should be used by Processwork Advanced Studies to provide a recommendation for an applicant to the self-guided program. This recommendation cannot be completed by the applicant’s personal therapist.

Please complete this reference form, sign and return directly to the Process Work Institute. This reference will become a permanent part of the applicant’s file. Email completed forms to , or print and sign them and mail them to the above address.

The Self-Guided Advanced Studies Program is intended for people with significant experience in Processwork who feel it is their path to study in a completely self-guided and independent way. The Self-Guided Advanced Studies Program is a non-local program of study. Students are responsible for creating their own curriculum of study by attending seminars, courses, and putting together a study committee to guide, support and evaluate their learning. Students may study anywhere in the world. However, final exams take place in Portland at PWI.

The recommendation should address the applicant’s ability to meet the following admissions criteria. Applicants should be:

  • self-reliant with demonstrated initiative
  • self resourced; able to put together the program they want, and responsible for designing their learning
  • excited by rigorous learning and personal development
  • have a plan or general sense of their development and learning
  • able to find mentors within the international and Portland Process Work communities

Information about the referee

Name

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FirstLast

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Organization

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Position

Contact

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Email

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Phone

Referee Declaration

I, …………………(insert referee name)…………………………………………., am a Processwork Diplomate from ………………(insert name and location of Diplomate program and year of graduation)……………………………….

I am not the personal therapist of ……………(insert applicant’s name)………………………….

Signed and dated

………………………………………………………………………………………..

Recommendation Questions

1. In what capacity have you known the applicant and for how long?

2. Why would you recommend the applicant for this course of study and what makes him or her valuable to the field?

3. How do you see the applicant’s ability’s to assist others in their growth and development? What do you see them contributing to the program?

4. Can the applicant function effectively in a learning environment that offers limited structure and requires a strong ability to function independently?

5. Does the applicant have the initiative required to locate and utilize professional and educational resources in the applicant’s community?

6. Describe the applicant’s emotional tolerance and capacity for working with conflict situations in themselves and in others.

7. Please comment on the applicant’s relationship skills and ability to work with others.

8.What challenges or difficulties do you anticipate the applicant might encounter in the program or as a facilitator of others’ growth?

Please comment on anything else that you feel is important for the admissions committee to consider. We appreciate your time and thoroughness.

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Reference SignatureDate

Please return this form to:

Process Work Institute

2049 NW Hoyt Street,

Portland, Oregon 97209

Phone: 503-223-8188

Fax: 503-227-7003

Email:

Website:

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