Letter Of Recommendation Release

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LETTER OF RECOMMENDATION RELEASE
"Statements made by a recommender which are made from the recommender's personal observation or knowledge do
not require a written release from the student who is the subject of the recommendation. However, if personally
identifiable information from the student's educational record is included in a letter of recommendation (grades, GPA,
etc.), the writer is required to obtain a signed release from the students which 1) specifies the records that may be
disclosed, 2) states the purpose of the disclosure, and 3) identifies the party or class of parties to whom the disclosure can
be made."
Guidelines for Postsecondary Institutions for Implementation of the Family Educational Rights and Privacy Act of 1974 as Amended, Revised Edition
1998, Richard A. Rainsberger, American Association of Collegiate Registrars and Admissions Officers
I authorize the following release:
1) Records which may be disclosed:
Any transcript information
Major and degree sought
GPA and specific course information
Other (specify):
2) Purpose of the disclosure:
Employment recommendation
Graduate or professional school recommendation
Other (specify):
3) Parties to whom the disclosure can be made:
____________________________________________________
(name)
____________________________________________________
(address)
____________________
______
____________
(city)
(state)
(zip)
____________________________________________________
(name)
____________________________________________________
(address)
____________________
______
____________
(city)
(state)
(zip)
____________________________________________________
(name)
____________________________________________________
(address)
____________________
______
____________
(city)
(state)
(zip)
____________________________________________________
(name)
____________________________________________________
(address)
____________________
______
____________
(city)
(state)
(zip)
____________________________________________________
(name)
____________________________________________________
(address)
____________________
______
____________
(city)
(state)
(zip)
__________________________
____________________________ ____________
Name
Signature
Date

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