RECOMMENDATION/REFERENCE REQUEST FORM
Complete this form if you are requesting recommendations from any of the School of Health Care Professions faculty. Be sure to give a
completed form to the faculty member when you are asking them to be a reference, or e-mail the form to the faculty member after you personally
ask the person for a recommendation. Many schools/programs require completion of their own recommendation form. Be certain to include
copies of any of these forms.
Student Name:
Date you contacted faculty to
complete a recommendation:
Name of Faculty Member that you contacted
to complete a recommendation:
Name of School or Scholarship
(Place an X in the adjacent box, if
there is an additional form to be
completed.)
Letter should be addressed to:
Deadline
date:
Check one of these
options:
I will
pick up
letter
1
2
3
4
5
Mail
directly
Address that recommendation
should be mailed to: