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					SENIOR FELLOWSHIP INDEPENDENT REFEREE REVIEW FORM

1. Identification
Applicant details Recognition (please refer to ref: page 1 of their Name: application) Institution: Your Independent Referee number (as quoted in covering email/letter)

2. Review and feedback
2.1 For each of the five Senior Fellow criterion please:   2.2 indicate whether the applicant meets/partially meets/does not meet the criterion provide comment and feedback on the validity of the applicant’s self-claim

Please note that Individuals may demonstrate different writing styles, and therefore the information you seek may not be set out under specific Senior Fellowship criteria headings. The feedback you provide should be as full and helpful as possible (ie not just positive) in order to assist the committee in determining whether to confer Senior Fellow status. Your comments may also be used to provide constructive feedback should an applicant be unsuccessful

2.3 2.4

SF Independent Referees Review Form 2008

Page 1 of 5

Criterion 1: Lead colleagues by personal example Comment and feedback:

Fully meets/partially meets/does not meet
[Please delete as appropriate]

Criterion 2: Facilitate and influence networks of colleagues Comment and feedback:

Fully meets/partially meets/does not meet
[Please delete as appropriate]

SF Independent Referees Review Form 2008

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Criterion 3: Impact positively beyond their institution, at national and international level, within their discipline or more generally Comment and feedback:

Fully meets/partially meets/does not meet
[Please delete as appropriate]

Criterion 4: Make a sustained contribution and positive impact to the student learning experience Comment and feedback:

Fully meets/partially meets/does not meet
[Please delete as appropriate]

SF Independent Referees Review Form 2008

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Criterion 5: Champion learning and teaching in HE Comment and feedback:

Fully meets/partially meets/does not meet
[Please delete as appropriate]

6. Please use the space below if you wish to make any additional comments on the applicant’s submission.

SF Independent Referees Review Form 2008

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3. Independent referee self-assessment
3.1 The information you provide here may be useful to the Senior Fellowship Committee in moderating the applications. Your self-assessment will be kept anonymous. These comments will not be passed onto the applicant. Please use the table below to indicate how confident you felt in reviewing the application: Confidence level Low 1. Lead colleagues by personal example 2. Facilitate and influence networks of colleagues 3. Impact positively beyond their institution, at national and international level, within their discipline or more generally 4. Make a sustained contribution and positive impact to the student learning experience 5. Champion learning and teaching in HE Please use the space below if you wish to clarify, or comment on your ability to review this application. Medium High

3.2 3.3

Data protection act statement
I agree that by submitting my assessment the information supplied on this form can be stored in paper and electronic format for use by the Professional Recognition Team and Senior Fellowship Committee. Print name: Electronic signature (if available): Date:

SF Independent Referees Review Form 2008

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