Referral Recommendation Application Form
Example 1
Name of student: Carrie Fisher
Provider name: Sunshine College
Diploma title: Access to HE Diploma (Health)
Unit title(s): Contemporary Issues in Healthcare
Assignment title(s): Report: Assignment 3
1. Details of referral recommendation. Please include the following:
 Special circumstances affecting the individual student
 The achievement in the original submissions and resubmissions for the
unit(s)
 The student's total achievement profile up to the point on the Access to HE
course that the referral is requested; title of units, credit value and
indicative grades, and whether or not they were achieved on the basis of a
second resubmission of work as a consequence of referral (This can be
appended to the application form).
The following assessment criterion has not been achieved:
AC 5.1. Write a report on a health care issue using language and style
consistent with academic criteria for health research including a) in text
referencing b) recognised referencing system.
This was not achieved on first submission. On resubmission Carrie again did
not meet the required standard. The work was not sufficiently in a “style
consistent with academic criteria for health research”.
Carrie has achieved the other units of the Access Diploma. She has performed
consistently at Merit level across the Access course and does appear to have
the ability to perform at Level 3 and write in an academic style. As this is the
only assessment criterion she has not achieved in the Diploma, and we
consider her to have the ability to do so, we would like to request a referral
opportunity for Carrie to resubmit the report one more time. It has been
explained to Carrie that it is not an automatic right to be granted a referral and
that, if she is allowed to resubmit again, her grades for the assignment will be
capped at a Pass.
To add to this, following discussions with our Diploma and Lead Moderator we
have been advised to provide more guidance for students on academic writing
skills and referencing before they undertaken their first graded piece of work.
We have therefore put an action plan in place for next year, which is aimed at
avoiding the circumstances of Carrie’s referral application.
Name of
Internal
Moderator
completing the
application:
Mark Hamill
Date: 29.06.17
2. Proposed arrangements for the second resubmission:
Date of submission: It is proposed that Carrie should re-write her report and submit it within 5
working days.
Date student work will be ready for verification by the External Moderator (Diploma or
Lead): 15th August 2017
Name of assessor responsible for providing support and assessing the resubmitted work:
Harrison Ford
Name of internal moderator responsible for internally moderating the resubmitted work:
Mark Hamill
3. Documentary evidence provided in support of application:
 Grade tracker for units and assignments achieved to date
 The completed Student Feedback Form (AP4) with details of the outcome of the original
submission and resubmission.
4. Endorsement by Senior Manager of the Provider:
I fully support this referral application and endorse the proposed method of
resubmission.
Name: A.
Guinness
Designation:
Head of
Department, HE
and Access
Date: 30.06.17
5. Diploma Moderator comments:
I am happy to endorse the referral recommendations.
The student has shown an understanding of how to reference throughout the
programme; only missing one criterion in the Unit. I consider this to be an area
for development in the teaching team and should not hinder the completion of
the unit and subsequently the Diploma. The proposed arrangements for the
second resubmission are appropriate
Name of
Diploma
Moderator:
W. Davis
6. Lead Moderator Decision:
i) Do you endorse the referral recommendation, and why?
Name of Lead
Moderator:
Yes. This student’s work has been moderated and overall progress is good.
Moderators have provided advice to the Access team on giving students more
constructive feedback on academic writing and referencing skills. It is fair that
this student be allowed a second resubmission for this one AC.
Date:
1st July 2017
Date: 6th July
2017
ii) Do you agree to the proposed arrangements for the second resubmission?
Yes
If no, what additional measures are required?
iii) Proposed date for the verification of the student’s achievement:
15th August 2017
Please submit the completed application to the Lead Moderator. The Lead Moderator will
confirm the outcome of the decision with the Internal Moderator and Senior Manager named on
the form.