Cover Sheet For Confidential Reference Letter

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Cover Sheet for Confidential Reference Letter
Attached is a confidential letter of reference for the sole purposes of college admission and
academic counseling.
College information
College or University: ____________________________________________________
Admissions Office address: _______________________________________________
Application deadline: ____________________________________________________
Applicant information
Name: ____________________________________________________
Soc. Sec. No. : ____________________________________________________
Home address: ____________________________________________________
Waiver
I hereby waive my right under the Family Educational Rights and Privacy Act of 1974 to view the
attached confidential letter of reference. I will not seek access to this reference letter in my file at the
college or university listed above.
Signature of applicant: ___________________________________________________
Date: ____________________________________________________
Author of reference
Michael Normile
Mathematics Department
Lexington High School
251 Waltham Street
Lexington, MA 02421

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