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Bachelor of Social Health and Wellbeing - Reference Form

Social health and wellbeing is an area of study and work relating to working in the mental health, addictions and disability sectors to support people to achieve the lives that they want to live. It involves understanding people, the systems that surround them and how to influence those systems to achieve positive outcomes.

The purpose of this report is to gather evidence of the applicant’s suitability for working with potentially vulnerable people in these sectors. The information provided by you is evaluative as stated in the Privacy Act 1993, Section 29 (3b) and will be kept in confidence as stated in the Privacy Act 1993, Section 29 (1b). 

Please complete all relevant sections of this reference in as much detail as possible. Please indicate the applicant’s level of personal skills and attributes as part of your overall recommendation. 

If you have any reservations regarding the applicant’s suitability, or any other information that you consider would help us make a decision about the applicant, please contact the Programme Leader by email or freephone 0508 650 200.


Thanks for taking the time to be a reference, any information you give us will be kept in confidence

Please complete and submit this form as soon as possible. We cannot process the potential student’s application until we receive this reference.

Name of applicant

Relationship with applicant

Are you completing this form:

ALERT:

Unfortunately we cannot accept references from friends or family members. Please leave this form and fill out this alternative form so we can notify the applicant. Thank you.

During what period have you known the applicant?

From (date)To (date)

Skills and attributes of applicant

Please comment on your observations of the applicant interacting with the following people:

(Please comment in which capacity the observation was made, and detail their interaction skills)

How would you rate the applicant in the following areas?

Support your rating with comments and examples. 

(Tick the ‘Not observed’ box if you have not had the opportunity to observe the applicant demonstrate any of the following).

Trustworthiness
Honesty
Reliability
Sensitivity and compassion
Respect for others
Personal insight and openness to feedback
Communication skills (speaking and listening)
Communication skills (writing)
Stress management skills

Overall recommendation

Do not complete this recommendation until you have answered all other questions on this form.

Acknowledgement of true information

Please tick this box to confirm that all information presented in this reference is true, complete and accurate.

Please tick the box to acknowledge you understand that this information will be used by Open Polytechnic to assess the applicant’s eligibility for admission into the Bachelor of Social Health and Wellbeing where they will be required to complete practica with service users.

Thank you for completing this form

Please select SUBMIT to complete the form.

We may wish to contact you to discuss your appraisal of the applicant. In the meantime, if you would like to contact us you can call freephone 0508 650 200.