Honours Program Academic Referee Form
The applicant is to complete Section 1 of the form and forward it to the relevant Academic Referee to complete the
remainder of the form. The applicant is responsible for ensuring that the nominated person has agreed to be listed as a
referee. The applicant is required to submit two (2) completed academic referee forms in total from 2 different referees,
along with the other documents required to apply for the Honours program. If you can no longer find a suitable academic
referee, you may wish to ask a current or previous employer to complete the referee form.
Please note that the academic referee cannot be a potential supervisor.
All documentation must be submitted as a completed application pack to the Postgraduate Research Coordinator at
pgr@endeavour.edu.au.
1. PERSONAL DETAILS (to be completed by the applicant)
Title
Given Name
Family Name
Email
Phone Number
Qualification
Year of completion
Institution
2. REFEREE REPORT (to be completed by the referee)
Title
Given Name
Family Name
Email
Phone Number
Position
Department
Institution
a) For what time period have you known the applicant?
During undergraduate studies: ☐ 3-6 months
☐ 6-12 months
☐ 1-2 years
☐ 2 years+
☐ 3-6 months
☐ 6-12 months
☐ 1-2 years
☐ 2 years+
During postgraduate studies:
Other, please specify: Click here to enter text.
b) In what capacities have you known the applicant?

Coursework Lecturer ☐

Head of Department/Institution ☐

Clinical Supervisor ☐

Postgraduate degree supervisor ☐

Other, please specify: Click here to enter text.
c) Please rate the applicant in comparison to other students who you have supervised and/or taught:
Top 5% ☐ Top 10% ☐ Top 15% ☐ Top 20% ☐ Top 25% ☐
Australian College of Natural Medicine Pty Ltd (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation
Honours Program Academic Referee Form - F-139
Version: 2.0
Effective Date: 10-Feb-16
Page 1
d) Please score the applicant on a scale of 1-10 (10 being the highest)
Creative Ability: ability to develop original ideas or approaches without prompting Choose an item.
Initiative: ability to embark on new ideas or approaches without prompting Choose an item.
Motivation: ability to complete a research degree Choose an item.
Planning: ability to keep to a schedule Choose an item.
Perseverance: ability to work in difficult circumstances Choose an item.
Critical Ability: ability to appraise and analyse information and arguments Choose an item.
Communication: oral and written skills in field of study Choose an item.
e) How would you assess the applicant’s research potential based on their academic records and your knowledge of the
applicant?
Click here to enter text.
f)
Please add any additional comments that you think are relevant to the application.
Click here to enter text.
3. DECLARATION (to be completed by the referee)
i. I declare that all information on this Academic Referee Form is correct and complete and that I am qualified to
comment on the applicant’s academic skills and experience.
ii. I have understand that the applicant is applying to enroll in a research qualification and have provided answers
above to the best of my knowledge around their capacity to undertake such a qualification. I also understand that
the College reserves the right to seek verification of the information supplied by me.
Signature
Date
OFFICE USE ONLY
Date Received
 Applicant Notified
 Filed
 Reviewed by Honours Degree Coordinator
Approved / Denied
Signature
Date
Australian College of Natural Medicine Pty Ltd (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation
Honours Program Academic Referee Form - F-139
Version: 2.0
Effective Date: 10-Feb-16
Page 2