Letter of Recommendation Release Form

Please type or use black ink.

I give my permission to: Health Professions References to write a letter of recommendation for  _______________________________________.
Candidate’s Name

According to the “Family Educational Rights and Privacy Act of 1974”, I am aware that I have the right to review my file materials in the Health Professions Office.

I do hereby waive ____   do not waive _____ my right to review this letter of reference. I will allow ______     do not allow ______ my reference writer to disclose in this letter any and all information contained in my educational record at the University of Maine or other educational institution listed

This information includes but is not limited to my grades, thesis, research, test scores, GPA, class rank and evaluation of my work.

________________________________________________            ______________________
Signature of Candidate                                                                        Date

Please return signed copy to:
The Health Professions
University of Maine
5748 Memorial Union
Orono, ME 04469-5748