Letter Of Recommendation Request Form

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Medical University of South Carolina 
College of Medicine 
 
Letter of Recommendation Request Form 
 
N
ame _________________________________________________________  Email ____________________________ 
*
Please attach a current curriculum vitae and any other relevant application information 
 
 
LETTER OF RECOMMENDATION DUE BY: _____________________________ 
 
*Expect a two­three week turnaround time for completion 
 
Letter of Recommendation for: 
 
Dual‐Degree
 Program 
 
Scholarship
 
 
Fellowship 
 
Transfer to another medical school 
 
National student organizatio
n position 
 
Other ________________________ 
 
Address the Letter of Recommendation to the following:  
 
School/Program Attention _____________________________________________________________________ 
 
Address  __________________________________________________________________________________________ 
 
S
pecial Instructions _____________________________________________________________________________ 
 
 
Upon completion of the letter: 
 
Please call me when the letter is ready
 to be picked up at (_____) ____________________ 
 
Please fax to (_____) ____________________ 
 
Please email the letter to ____________________ @ __________. ________  
 
Please mail the letter in the addressed and stamped envelope that I provided.  
 
 
_______________________________________________________       _____________
__________ 
Student Signature 
 
 
 
 
Date 

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