Matrix College of Counselling &
Psychotherapy
Dear Referee,
Applicant’s name:
Course applied for: Certificate in Creative Counselling for Children & Young
People
The person named above is applying to join the above course at Matrix College.
The applicant would like you to support his/her application and will have sent this
form directly to you. Matrix has adopted this process of confidential reference
requests to assist referees in providing appropriate information in determining the
applicant’s suitability for training.
Referees should either be an employer/manager or someone who is familiar with
the applicant’s work clinically.
We would be grateful if you would complete the following page. Alternatively, you
can attach this form to a separate email giving your opinion of this applicant, in
which case it would assist us if you could refer to the numbered questions in
providing your personal statement.
Please return this form with your comments by post or email to the Matrix
Administrator Clemmie Gleeson, email: clemmie@matrix-training.org
Many thanks for completing this form.
Yours sincerely
Alison Dart
Deputy Head of Training
Reference Form
Referee information
Full Name:
Address:
Tel.no
Mobile no.
E-mail Address:
Position/occupation/relationship to applicant:
To help us further with our assessment of this applicant, it would be helpful if you could rank the applicant
with regard to the following:
Low
High
Motivation and commitment
1
2
3
4
5
Readiness for counselling training
1
2
3
4
5
An understanding of the demands of
training e.g. deadlines, assessments, oral
and written communication
1
2
3
4
5
Capacity to engage with people
1
2
3
4
5
Ethical Integrity and clear values
1
2
3
4
5
Statement by Referee
Statement by Referee
Please provide an additional statement below outlining your view of the candidate's suitability for pursuing this course
of study.
Signed:
………………………………………………………………
Date:
……………………………………………………………….