STUDENT REQUEST FOR A FACULTY RECOMMENDATION

I am giving permission to______________________________________________

to write a letter of recommendation for me.

I request a letter of recommendation to be sent to the following person:

Name and title ____________________________________________

Name of agency___________________________________________

Complete address including zip_______________________________

The recommendation is for (give as many details as possible)—

Scholarship (specific name & type of scholarship)_____________________

Summer student extern __________________________________________

Summer employment____________________________________________

Full time employment___________________________________________

Other________________________________________________________

You have my permission to report grade point average, progress, etc. Yes___   No___

Do you prefer the recommendation be

(a)    sent directly to the above named person_______

(b)   placed in a sealed envelop for you to pick up_____

Date recommendation is needed____________________

Other comments_______________________________________________

Your signature_____________________________________

Today’s date___________________  Expected graduation date______________

Phone number where you may reached__________________