Letter Of Recommendation Request Form


Letter of Recommendation Request Form
(jpg revised 3/15)
Return this form, along with the Permission Document (waiver), to Faculty letter writer
at least 2 weeks prior to due date.
Name: __________________________________-________ Date: _______________
Do you waive your right to see your letter of recommendation? YES ___ NO ___
Deadline for letters: _____________________ ** allow at least 2 weeks, 3 preferred
Address: ________________________________ Tel #: _______________________
________________________________ Email: _______________________
Academic Record
Total # hours completed: ________ Total # of hours in psychology: __________
Overall gpa: ________ Psychology gpa: _______ Last 2 years gpa (optional): ______
Standardized test scores (e.g., GRE): _________________________________________
Major: __________________ Minor: ______________ Date of Graduation: ________
List classes taken and grades received from the instructor who will write your letter:
* For the info below, provide estimate of the number of hours worked (e.g., “10
hours/week (total 100 hours), working as a student mentor, Winter qtr, 2005”)
* Student Activities
* Experience
Psychology related experience (e.g., research work; 693; include duties/responsibilities)
Off campus work experience (e.g., volunteer work; other work experience)
Family responsibilities (and/or special circumstances that you want mentioned in your


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