2016 GIM Level 1 - Referee Form
15 February 2016
and applicants may be disadvantaged if referee forms are received late. Please do not send the reference form to the applicant. Thank you for completing this form.
Type of Referee
Name of Referee
Title / Position
Name of Applicant
How long and in what capacity have you known the applicant?
The applicant is applying for a course of study that involves experiential and didactic training. Please comment on the applicant’s abilities in the following areas:
Relating to people:
(e.g. strengths, honesty, reliability, conscientiousness.)
Capability in situations requiring flexibility and sensitivity (Professional only):
Clinical/therapeutic skills (Professional only):
Administrative and organizational skills (Professional only):
Are there any reasons why this applicant may not be suitable for experiential training at this time?
Yes (specify reason)
I recommend the applicant for the course.
I do not recommend the applicant for the course.