Sample Letter Of Reference Template

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Graduate Admissions Office
Letter of Reference
To the Applicant:
Please complete all entries above the dotted line.
Print Full Name ________________________________________________________________ S.S. # _______________________
Year and Semester of Expected Enrollment:
Year ____________________
Program of Study _______________________________________________ Program Code No. ___________________________
Name of Recommender ______________________________________________________________________________________
I am aware of the rights afforded to me by the Federal Educational Rights and Privacy Act of 1974, as amended.
I hereby
do not waive my right to examine the contents of this reference. I understand that by waiving my right I do
so under the condition that the reference is used solely for the purpose for which it is requested.
Date __________________________________ Applicant’s Signature _________________________________________________
To the Recommender:
The student whose name appears above has applied for admission to a master’s program at Queens College. This form is
submitted to you for your evaluation of the applicant’s qualifications both for graduate study and for a fellowship or an
assistantship. Please tell us how long you have known the applicant and what you know about his/her academic ability, and
include any other information that might make a difference concerning the student’s application. (If you prefer not to use
this form, please send your statement on official institutional letterhead.)
How would you compare this student with recent graduates in his/her field?
Upper Tenth
Upper Third
Below Average
Date ____________________________________ Recommender’s Signature ___________________________________________
Recommender’s Name and Title (please print) ___________________________________________________________________
Institution __________________________________________________________________________________________________
Address ____________________________________________________________________________________________________
Phone # _________________________ Fax _________________________ Email ________________________________________
Graduate Admissions Office | 65-30 Kissena Boulevard | Flushing, New York 11367-1597
718-997-5200 | Fax 718-997-5193 |


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