Student Request for Letter of Recommendation

Name of Student _____________________________________

I authorize the following release of information about my Sonoma State University student records:

Person you are requesting write the recommendation letter _______________________

Name and address of the person or organization to which the information will be released

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Purpose of the letter of recommendation

___ Employment Recommendation

___ Recommendation for admission to another university or to a Sonoma State University program

___ Scholarship recommendation

___ Other (please specify)

___________________________________________________________________

Records that may be disclosed (check as many as appropriate)

___ Any transcript information

___ Major and degree sought

___ GPA and specific course information

___ Other (please specify)

___________________________________________________________________

I request that the faculty member or other University employee named above write a letter of recommendation to the person or organization named above. I grant permission to include my grades, GPA, class rank and other information concerning my performance as a student.

___ I waive my right to review a copy of this letter at any time in the future.

___ I do not waive my right to review a copy of this letter at any time in the future.

Signature of student __________________________________

Date______________