Honors College Request for Letter of Recommendation

A letter of recommendation should be complete and specific. Therefore, to assist you in your request, we ask that you complete this form.

Name

First NameLast Name

Student ID

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

student@my.pbsc.edu

Purpose of Recommendation

Address the letter to

Deadline date you need the letter

MonthDayYear

Please list any scholarships you have received (include dates where appropriate)

Please list any awards or special recognition's you have received (include dates where appropriate

Please list your involvement in the Dr. Floyd F. Koch Honors College and graduation track

Please list your community service and how that has helped you (include dates where appropriate

Please list your hobbies and non-academic interests

Briefly describe your academic and career goals

Do you want the letter sent directly you?

Note: Please check with the institution or person to whom you are sending the letter. Many institutions will not accept letters that are mailed or submitted by students.

Address where letter will be sent

Street Address

Street Address Line 2

CityState

Zip Code

PERMISSSION TO RELEASE NON-DIRECTORY INFORMATION
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. According to FERPA guidelines, non-directory information cannot be released to third parties without the student's consent. Examples of non-directory information include: GPA, class grades, exam scores, class rank, standardized test scores, social security number, student ID, birth date, gender, religious affiliation, ethnicity, citizenship, nationality, marital status. For more information about your rights, visit: http://www.ed.gov/policy/gen/guid/fpco/ferpa/students.html

I give permission to the Honors College to access my academic records and write a letter of recommendation to

Name of person, business, institution, or organization

I give my permission to include the following non-directory information in this letter

Other

I consent the release of my information to the above identified party

Type your full name as your electronic signature

Date

MonthDayYear

Do you waive your right to review this recommendation letter?