Biochemistry and Molecular Biology
Penn State Science
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Request for Letter of Recommendation

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This form should NOT be used as initial contact to request a letter of recommendation. Only use this form after a faculty member has agreed to write a letter for you.

This form can be used to consent to the release of non-directory information for the purposes of an evaluation.  In addition to consent, the form is used to provide the evaluator with relevant information such as a list of schools or programs that require a letter and the associated deadlines.

 

1. When did you first contact the Professor/Evaluator about writing a letter?
Date of Contact  
/ /  
2. Student Contact Information
3. Professor/Evaluator Requested
School/Program Make a complete list of all schools/programs that require a letter as well as the deadline for each letter. If you are applying to more than 10 programs, or if after completing this form you decide to apply to more schools, you must complete another form.
School/Program 1
Purpose of Request




Type of Request



Delivery Method



Deadline for submission
/ /  
School/Program 2
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Type of Request



Delivery Method



Deadline for submission
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School/Program 3
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Type of Request



Delivery Method



Deadline for submission
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School/Program 4
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Type of Request



Delivery Method



Deadline for submission
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School/Program 5
Purpose of Request




Type of Request



Delivery Method



Deadline for submission
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School/Program 6
Purpose of Request




Type of Request



Delivery Method



Deadline for submission
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School/Program 7
Purpose of Request




Type of Request



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Deadline for submission
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School/Program 8
Purpose of Request




Type of Request



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Deadline for submission
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School/Program 9
Purpose of Request




Type of Request



Delivery Method



Deadline for submission
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School/Program 10
Purpose of Request




Type of Request



Delivery Method



Deadline for submission
/ /  
11. Waiver  

By submitting this form, I consent to the release of any information from my educational record (e.g. grades, GPA) that is deemed appropriate for purposes of the recommendation or evaluation.