To the applicant: Download this form and email to your recommender.
To the recommender: When you have completed this form, please save and send to admission@pitzer.edu.
Pitzer College
Name:____________________________________________________________________________________________________Gender:_______________
Maiden/previous name(s)_________________________________________________________________________________________________________
Address________________________________________________________________________________________________________________________
Street City/Town State Zip Code
Telephone number (_______)______________________________________Email____________________________________________________________
I am applying as a New Resources candidate for: Fall 20____________
Applicant Waiver
Please select one:
I waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
I DO NOT waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
Signature___________________________________________________________________Date_______________________________________
To the Professor/Supervisor: The Admission Committee at Pitzer College would be grateful if you would ll out this form for the above named
applicant. All information will be held in strict condence. In no case will the applicant be able to inspect this document. The applicant’s
decision concerning the waiver will not affect his or her admission to Pitzer College. This reference will not be a part of the student’s permanent
le. Please return this form as soon as possible.
Please print name________________________________________________Position/Title____________________________________________________
Subject taught to applicant/relationship to applicant_________________________________________________________________________________
Institution’s name __________________________________________________________________Phone (________)______________________________
Address________________________________________________________________________________________________________________________
Street City/Town State Zip Code
How well do you know the applicant?______________________________________________________________________________________________
Please comment on the following characteristics:
Academic ability_________________________________________________________________________________________________________________
Motivation______________________________________________________________________________________________________________________
Please comment on the candidate’s ability to express himself or herself:
Writing_________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Speech_________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
NEW RESOURCES PROGRAM
REFERENCE FORM
Last/Family First/Given Middle/Complete
Pitzer College, 1050 North Mills Avenue, Claremont, CA 91711 909.621.8129 Fax: 909.621.8770 www.pitzer.edu
