Instructions to Applicant: Please complete the information requested below and give this form to an appropriate person who is familiar with your educational background and abilities. Please type or print:

Name of Applicant:

(First)________________ (M)__________ (Last)__________________

Applying for:
Admission ____________________________________________

Graduate Award _______________________________________

Department ___________________________________________

Degree Objective ______________________________________

Under the Federal law entitled the Family Educational Rights and Privacy Act of 1974 and the University of Oregon Student Record Policy, registered students are given the right to inspect their records, including letters of recommendation. Opinion is divided whether letters open to review are more helpful in assessing a student’s potential than those which are not. Should you wish to waive your right to this evaluation, you may do so by signing the waiver below. In any case all evaluation will be carefully considered.

I expressly waive any rights I might have to access to this recommendation under the Family Educational Rights and Privacy Act of 1974, the University of Oregon Record Policy, or any other law, regulation or policy. I understand that the University of Oregon does not require me to execute this waiver and is willing to review my application whether or not I sign it.

Date:____________ Signature:______________________________

To Person Making Evaluation: As required by the Family Educational Rights and Privacy Act of 1974 and the University of Oregon Student Record Policy, a student may either elect to waive or not to waive the privilege of viewing this recommendation form. If the student has not signed the above waiver you should consider this form to be non-confidential.

We do request that you use this form on the next page for your recommendation and return it directly to the department named above. If you need room for additional comments please feel free to attach an additional page.