Letter of Recommendation Request Form
Applicants are to fill out the top portion of this form and give it on to the person writing the letter of
Name of Applicant:
Seaver Graduation Date:
(please type or print neatly)
Type of school that I am applying to (check one):
o Allopathic (MD)
o Osteopathic (DO)
According to the Family Education Rights and Privacy Act, I may waive the right to see this application by signing
the waiver below (check one of the following):
o I waive my right to see this evaluation.
o I do not waive my right to see this evaluation.
Name of Evaluator:
Please indicate your overall rating of this student on the scale below in addition to writing a letter of
recommendation. It will be more helpful to the student if you can comment about your personal relationship with
the student rather than summarizing their resume. Your direct experience with them and illustrations of their
character and motivation for medicine are most helpful.
Please address your recommendation letter “Dear Admissions Committee”
not to any of us.
Recommendation Rating (check one):
o Recommended with enthusiasm
o Recommended with confidence
o Recommended with reservation
o Not Recommended
Please return this form with your letter of recommendation (on letterhead) by PDF or regular mail as well as
by e-mail to the address below. We create an electronic letter file from your letters using Virtual Evals.
Thank you so much for your help!
Ms. Patricia Scopinich
Natural Science Division
24255 Pacific Coast Highway
Malibu, CA 90263-4321