Letter of Recommendation Information and Request Form
Revised 10-2011
Dear , I am applying for the following internship, scholarship or college:
(Please be specific):
I am requesting a Letter of Recommendation to support my application. For your convenience I am
including the following information. I have also attached a copy of the application requirements. Please
do not hesitate to contact me for additional information or clarification.
Name: Date of request:
High School Attending: Year in school: GPA:
Date recommendation is needed: Number of copies needed:
❏ I will pick up the recommendation.
❏ Please email the recommendation to:
❏ Please mail the recommendation to:
Name:
Title:
Organization:
Mailing Address:
City, State and Zip code:
❏ Other special instructions:
Educational and/or career goal(s):
Personal characteristics supporting potential for success, noteworthy achievements:
Applicable work, educational or volunteer experience (attach resume):
