St. Olaf College - Student Request for Reference or Recommendation

Date: ______________________

To: ______________________

(Faculty/Staff Member Name)

From: ______________________

(Student Name)

I give you permission to review, quote, and give other information as needed from my official St. Olaf College transcript and from my other education records held by the college to the names and addresses listed below for the purpose of (check all that apply):

Writing a letter of recommendation or reference;

Filling out the attached reference/recommendation form;

Completing an evaluation form;

Releasing information verbally; and/or

Other (Specify)

List names, addresses, and phone numbers for this request:

________________________ ______________________

________________________ ______________________

________________________ ______________________

________________________ ______________________

________________________ ______________________

________________________ ______________________

________________________ ______________________

________________________ ______________________

(Attach list of additional names)

This request must be fulfilled by ____________.

(Date)

Student Signature: ____________________________ Date: __________