Guidelines For Requesting Letters Of Reference (Page 3 of 3) in pdf

Guidelines For Requesting Letters Of Reference Page 3

RELEASE FORM FOR WRITTEN LETTERS OF REFERENCE

REFERENCE REQUEST

I request ____________________________ to write a letter of reference on my behalf. In accordance

with the Family Educational Rights and Privacy Act of 1974 (PL 93-380), you may be shown reference

letters upon request unless your right is waived.

I waive my right to access the reference letter. __________________________ (your signature)

I do not waive my right to access the reference letter. _____________________ (your signature)

Purpose of reference letter:

Scholarship application to

____________________________________________________

Research position with

____________________________________________________

Employment by

____________________________________________________

Volunteer activity with

____________________________________________________

Other

____________________________________________________

Recipient of Reference Letter:

Name:

___________________________________________

Title:

___________________________________________

Address:

___________________________________________

Email address: ___________________________________________

Student (print name): ____________________________________

Date of request for reference letter:

_______________________

Date reference letter is needed by recipient:

________________

Guidelines For Requesting Letters Of Reference Page 3