Request for Letter of Recommendation

Please fill out this online form, print, sign, and present to the individual making the recommendation.

Please fill out this online form, print, sign and present to the individual making the recommendation.

Authorization
Please enter name of person/organization you authorize to submit a recommendation.
Name of Professor or Other University Official or Organization

Send To
Please enter the name of the person or place to send recommendation.
Please enter street address.
Please enter city.
Please enter zip code.

Evaluation Requirements
Please enter name of person/organization you authorize to submit a recommendation.

For the purpose of:


I consent to the release of any information from my education record (e.g. grades, GPA) that is deemed appropriate for purposes of the recommendation or evaluation.

Waiver to View Recommendation

Student Identification
Please enter your name.
9-digit Penn State ID number
Please enter your PSU ID.

Please review your entries on this form. If all information is entered correctly, please print, sign, and present it to the individual making the recommendation.

Student Signature

Student Signature: _________________________________________________

Date: ____________________________

Student Signature: _______________________________________ Date: __________________________

Office Use Only

Is a disciplinary review required?

Last Revised: 11/18/09