Reference Form

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Referee's Name
Referee's Address
Applicant Student Name (as per passport)
The applicant student named above has applied for a place on a Cork Counselling Services Training Institute course. They have named you as a Referee to support their application. In order that we can assess the applicant’s suitability we would appreciate if you would fill out the following questionnaire. If you have any questions or concerns about any matter, please feel free to contact Ms Karen Walsh, Head Of Training on 021-4274951
Clear Signature

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