Advisory Committee for the Health Professions
Committee letter request form
Student’s name ________________________________ email:_____________________
Date ___________ Phone:____________________
I request that a committee letter of evaluation be written on my behalf. This letter will be
sent to (check one)
Medical schools
Dental schools
Veterinary schools
Podiatry schools
Optometry schools
Other (note here) ______________________________
The individual letters of recommendation I have requested which should be on file with the
committee are:
Recommender’s name Date requested
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
_________________________________________ _______________
Students take note:
This request needs to be submitted to the chair of the ACHP well in advance (at least four
weeks, preferably 6-8 weeks) of your secondary applications being due. The entire committee
contributes to this letter, and it takes a long time to write and rewrite.
On a separate sheet of paper, you need to list the schools to which the committee letter will
be sent, along with addresses, to the Arts and Sciences division office. We will not look up
addresses for you. A template is available from the ACHP web site.
I waive my right to see the committee’s letter.
I do not waive my right to see the committee’s letter.
Student’s signature:
Date:
