School of Nursing Prelicensure Letter of Recommendation Request

FERPA Consent to Release Form

Prelicensure Letter of Recommendation & Letter or Recommendation Release

School of Nursing prelicensure and CEIN undergraduate students are encouraged to use this form to submit requests for letters of recommendation or completion of skill surveys from the faculty or the program director, for employment/internship opportunities or for graduate school application. Please note that the turnaround time for a request is approximately two weeks. "Statements made by a recommender which are made from the recommender's personal observation or knowledge do not require a written release from the student who is the subject of the recommendation. However, if personally identifiable information from the student's educational record is included in a letter of recommendation (grades, GPA, etc.), the writer is required to obtain a signed release from the students which 1) specifies the records that may be disclosed, 2) states the purpose of the disclosure, and 3) identifies the party or class of parties to whom the disclosure can be made." Guidelines for Postsecondary Institutions for Implementation of the Family Educational Rights and Privacy Act of 1974 as Amended, Revised Edition 1998, Richard A. Rainsberger, American Association of Collegiate Registrars and Admissions Officers.

Name(Required)
Select your program:(Required)
Academic Information which may be disclosed:(Required)
Purpose of the disclosure(Required)
What are you requesting today?(Required)
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.

Which facility, organization, or academic program does the faculty member have permission to disclose information to?

Address(Required)
Address
Address
This field is for validation purposes and should be left unchanged.