Applicant’s name Referee’s name Referee’s institution

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University of Essex Doctorate in Clinical Psychology Application
Academic Reference Form
Date:
Applicant’s name
Referee’s name
Referee’s institution
Referee’s job title/position
Course/programme studied by applicant
Start/end date of enrollment
Relationship with applicant at time of study
(tutor, course lead etc)
Applicant’s academic ability (including performance on the course, ability to apply academic
knowledge, ability to interact with peers and academic staff, potential for doctoral level training,
ability to work to course deadlines):
Please email this form to [email protected] We only accept references sent from an official/institution email
account (ie not gmail or yahoo etc).
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