Letters of Recommendation Form

Instructions

Please complete all necessary information and then print out this form and give it to each faculty member whom you have asked to write letters for you.   
_____________________________________________________________________________________

Full Name:                                                                                                             Date: 

Campus Address and Phone: 

Permanent Home Address and Phone: 

Use of Letters (check all that are appropriate) 

_____ Waive right to access   	_____ Retain right to access

_____ Graduate School		_____ Health Professions 	_____ Internship

_____ Employment     		_____ Study Abroad
  
References (list all of the people whom you have asked to write a letter of recommendation)

Academic Background 

Academic Advisor: 

List of Biology, Chemistry, Math, and Physics Courses Completed: 

Course Name			Term / Year			Grade

Overall GPA: _________     Biochem GPA: __________

Courses Taken From the Person Writing This Recommendation 

Course Name			Term / Year			Grade

Senior Project (if applicable)

    Senior Project Advisor:

    Senior Project Title: 

Summer Research Internships (indicate when and where the internship was conducted and the title of your research project)

Previous Employment: (list all summer, full time, and college employment since graduation from high school.  Also include any work-study positions that you held during the school year).

Position		Year         	 Responsibilities

Honors and Awards: 

Membership in Organizations: (include honorary societies) 

Extracurricular Activities: 

Other information: (include additional information about yourself that you think might be helpful to the person writing you a letter)

Addresses and Due Dates: (please list the addresses and due dates for the letters of recommendations.  If you are applying to more than one department at a specific school, give each departmental address)

Addresses							Due Date