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