PhD in PSYCHOLOGY:
CONSCIOUSNESS & SOCIETY
Letter of Recommendation
This form is to be completed by the applicant and given to the individual submitting the letter
of recommendation on the applicant’s behalf. It should then be attached to the letter of
recommendation. This form and the letter of recommendation must arrive in a sealed, signed
envelope. Please return the signed, sealed envelope to applicant to include in his/her application
packet. Thank you.
Last 4 digits SSN or UWG ID____/____/____ Name of Applicant: _________________________
Please Type or Print
Under the provisions of the Family Educational Rights and Privacy Act of 1974 (Public Law 93-
380), you may decide whether letters of reference written at your request are to be held confidential,
or whether they are to be available for your personal inspection. Check one of the following
statements and place your signature in the space provided so that the individual completing this form
and the Graduate School will be advised of your choice.
_____ Confidential. I waive my right of personal access to this reference and grant permission for
this letter of recommendation to be held confidential by the University of West Georgia.
_____ Open File. I retain the choice of having letters of recommendation available to me.
Signature of Applicant: ____________________________ Date:__________________________
Attach completed form to the Letter of Recommendation and return it to:
The College of Social Sciences
Pafford Hall
University of West Georgia
1601 Maple Street
Carrollton, GA 30118.
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