Referee Questionnaire

Bachelor of Social Work, Paetahi Tumu Kōrero - Bachelor of Counselling, Bachelor of Physiotherapy, and Bachelor of Midwifery.

Referee’s Details

Required *

Your Name *

Your Email Address *

Your Telephone Number *

Your Address *

Your relationship to the applicant eg current employer, supervisor, Minister, Justice of the Peace, Kamatua, Kuia, teacher, coach etc

Do you want the information you supply to be confidential to Wintec staff?

Yes

No

Do you know the applicant well enough to complete this form? If “yes” please select yes and continue. If “no” please select no and click submit at the end of this form. *

Yes

No

Applicant’s Details

Full Name

Date of Birth (if known)

Please describe your relationship to the applicant and how long have you known them?

What qualities do you appreciate in the applicant that suggests that s/he will make an effective health or social care professional?

What areas do you believe the applicant needs to develop?

Why do you believe the applicant will be successful in a health or social care profession?

Based on your experience, how will the applicant meet the challenges of a demanding degree programme? *

What reservations (if any) do you have about the applicant’s ability to meet the challenges of a demanding Degree programme?

Any further comments that you would like to add?

Would you recommend this applicant to study and enrol in this Degree programme?

Yes

No

Not sure

What programme is the applicant applying for?

Bachelor of Midwifery

Bachelor of Physiotherapy

Bachelor of Social Work

Paetahi Tumu Kōrero - Bachelor of Counselling

Unsure

Please explain this applicant’s engagement within your community and the impact of their engagement.

Self-Declaration

I declare that to the best of my knowledge the answers I have provided are correct. I have not withheld any information that could have a material bearing on the applicant’s enrolment. *

I agree

I disagree