Applicant Reference Form

CareNet Counseling
Residency in Psychotherapy and Spirituality
Applicant Reference Form

We appreciate your help in assessing the applicant’s readiness for admission. Please be frank, feel free to exceed space limitations, and offer comments not covered by our questions here. Your responses will be kept confidential and will be useful both in the admission process and in guiding the applicant’s training.

Applicant's Name *This question is required.

In comparison with other students or persons with whom you have worked, please rate the applicant in the following trait areas. A rating of 0 means you have had insufficient opportunity to observe this trait. A rating of 1 refers to the bottom 20%; 2, from 20% to 40%; 3, from 40% to 60%; 4, from 60% to 80%; 5, the top 20%.

Intelligence. Alertness, curiosity, capacity to conceptualize significant ideas, express self verbally and in writing. *This question is required.

Comments

Psychological stability. Capacity to exercise emotional control, manage stress, practice self-care, and maintain good relationships. *This question is required.

Comments

Interpersonal skill. Capacity to relate genuinely and amicably with others, to be honest and elicit trust from others, to work as member of a team. *This question is required.

Comments

Multicultural and social awareness. Attention and sensitivity to realities of diversity, concern for social issues. *This question is required.

Comments

Capacity for leadership. Ability to inspire others, maintain their confidence, take responsible risks. *This question is required.

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Responsibility. Can be counted on to keep commitments in a timely manner, capacity to solve problems creatively and effectively. *This question is required.

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Empathy. Capacity to understand other persons’ thought, feelings, and behaviors, ability to convey such understanding. *This question is required.

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Overall evaluation. Applicant’s overall potential as a therapist. *This question is required.

Comments

Applicant Reference Form

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