FERPA AUTHORIZATION TO RELEASE INFORMATION OR REQUEST FOR LETTERS OF RECOMMENDATION

TO: __________________________________________________________________ (Name of University Official and Department)

(CHECK ALL APPLICABLE AREAS)

Please ___write a letter or recommendation

___complete evaluation form

___release information verbally

___other(specify)___________________________________________________

(CHECK ALL APPLICABLE SPACES)

TO: ___all potential employers

___any educational institution

___only to the following______________________________________(specify)

(CHECK ALL APPLICABLE SPACES)

For the following purpose: ____employment

____admission to an educational institution

_____ all forms of scholarship or honorary award

____other (specify)______________________________

I authorize you to consult my educational record at Vanderbilt University to reveal such information from my educational record, as you consider appropriate for the purpose stated above, including information pertaining to my education at other institutions I have previously attended which is a part of my education records at Vanderbilt.

I waive ( ), do not waive ( ) – check one – my right to see the recommendation or other information prepared pursuant to this release.

Name (print)_____________________________

Signature________________________________

Student ID Number________________________

Date_____________________________________

Recommendation Form.doc