LeƩer of RecommendaƟon
Permission to Release EducaƟon Record InformaƟon
Student Name: _________________________________ Student ID Number: ____________________
I authorize ________________________________________ to write a leer of recommendaon on my behalf to:
The following informaon may be included in the recommendaon leer (mark all that apply):
Grades Courses Aended
GPA Academic Performance
Class Rank Other: _________________________________________
Check one: I waive I do not waive my right to review a copy of the leer at any me in the future.
Student Signature Date
Note: Please assist the faculty member in preparing your reference by providing supporng informaon along with your request.
Examples of informaon that might be helpful: a resume, a transcript, samples of previously completed academic work, etc. and informaon
about the graduate program or posion for which you are applying.
This form is being provided to assist you and your faculty in the permission process for student recommendaons and references. The form
has been draed using the sample leer provided by the American Associaon of Collegiate Registrars and Admissions Officers (AACRAO)
and complies with the Family Educaonal Rights and Privacy Act (FERPA) which requires wrien permission before releasing student
informaon to a third party.
It is recommended that this release be kept on file for at least one (1) year. If you have quesons concerning the confidenality and release
of student informaon, please contact the Registrar's Office at (805)437-8500 or registrar@csuci.edu
Please submit this form to the individual who you have requested the Leer of Recommendaon from.
Recipient Name
Phone number
Address
Email
Updated: 09/11/2019
