<p> Form CYC: BT2</p><p>Faculty of Health Sciences</p><p>DEPARTMENT OF COMMUNITY HEALTH STUDIES CHILD AND YOUTH CARE PROGRAMME</p><p>Application for Entry into the B.Tech: Child and Youth Development (Child and Youth Care) for 2018: </p><p>CONFIDENTIAL REPORT</p><p>Please note:</p><p>1. No application will be considered if no confidential report for the applicant is received.</p><p>2. This confidential report must be submitted DIRECTLY to the Child and Youth Care Programme, and NOT to the applicant.</p><p>Name of applicant: ______</p><p>For how long have you known the applicant? ______</p><p>In what capacity do you know her / him? ______</p><p>Write a brief report on the applicant’s abilities in terms of the following aspects:</p><p>1. Motivation to study: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>1 2. Ability to integrate theory and practice: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>3. Initiative and enthusiasm: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>4. Ability to read, write, speak and understand English: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>5. Interpersonal skills: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>6. Academic ability: ______</p><p>______</p><p>______</p><p>2 ______</p><p>______</p><p>______</p><p>7. Leadership: ______</p><p>______</p><p>______</p><p>______</p><p>8. Personal and professional development of the applicant in the time that you have known her / him: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>9. Professional integrity: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>10. Particular strengths: ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>3 RECOMMENDATION (please tick appropriate box)</p><p>Would you recommend this applicant for the B.Tech: Child and Youth Development?</p><p>YES NO</p><p>Please provide reasons for your recommendation.</p><p>______</p><p>______</p><p>______</p><p>Referee’s full name: ______</p><p>Position: ______</p><p>Organisation address: ______</p><p>______</p><p>Contact details: ______</p><p>______</p><p>Signed: ______Dated: ______</p><p>Thank-you for completing this confidential report. Please submit by Friday 29 September 2017 directly to:</p><p>Jackie Winfield Department of Community Health Studies Child and Youth Care Programme Durban University of Technology P.O. Box 1334 DURBAN 4000</p><p>Fax: 086 674 0558 E-mail: [email protected]</p><p>4</p>
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