Release for Letter of Recommendation Form

Use this form to provide faculty permission to provide a letter of recommendation for you as a student.

The type of information I provide permission to release are as follows:

My academic performance during the OT program.
My professional behavior during the OT program.
My leadership performance during the OT program.
My therapy skills and performance observed in class, lab, clinical, and community activities during the OT program.
My social skills, attitude and personality characteristics demonstrated during the OT program.
Any other information about my performance in the OT program.

All fields marked with asterisk (*) are required.

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Your Name:*

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Name of faculty member(s) that you give permission to provide personal or work references/recommendations for me upon request from me or another party through a written letter or online form or oral presentation.*

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I hereby, ____ Waive or ____ Do Not Waive my right to review a recommendation letter or know the contents of any oral or other communication.*

Waive

Do Not Waive

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Date Submitted:*

Link (required)