OFFICE OF COLLEGE ENROLLMENT
..........................................
Letter of Recommendation
STUDENT'S NAME:
Last:____________________________ First:______________________ Middle:________________
Type of reference: ❑ Doctor of Chiropractic ❑ University or College Faculty
Indicate Campus: ❑ Davenport Campus – Davenport, Iowa
❑ West Campus – San Jose, California
❑ Florida Campus – Port Orange, Florida
APPLICANT:
You may waive your right (under the Family Education Rights and Privacy Act of 1974) to review letters
of recommendation. Such action is optional.
I waive my right to review recommendations and evaluations in support of my application.
Signature: _______________________________ Date: ______________________________________
REFERENT:
In order for the letter of recommendation to be official, the letter should be written on letterhead. When
preparing this letter, you should be aware that your recommendation will be carefully reviewed and given
considerable weight as part of the admissions process. Therefore, we ask that you be open and candid in
your responses, and take the time to comment at length upon the applicant's character. These personal
insights are key to Palmer College achieving a combination of excellent people as well as excellent student
chiropractors. Should the Admissions Department have questions regarding your recommendation, we
may call you for further elaboration.
> Please outline the qualities you feel the candidate possesses that will enable him/her to be
successful in both the academic and professional settings.
> For how long and how well have you known the candidate?
> For chiropractor only: Briefly describe why you believe this person would be an asset to the
chiropractic profession.
Referent's name: _____________________________________________________________________
Position: ________________________ Course Title: _______________________________________
Referent's Signature: __________________________________ Date: __________________________
Phone number: _____________________________________________________________________
Address: ___________________________________________________________________________
City: ____________________________ State: __________ Zip: ______________________________
E-mail: ____________________________________________________________________________
Please return this form along with letter of reference to:
Palmer College of Chiropractic
Attention: Office of College Enrollment
1000 Brady Street
Davenport, Iowa 52803
Phone: (800) 722-3648 or (563) 884-5656
Fax: (563) 884-5414
