Request Form for a Letter of Recommendation
Name: __________________________________________
Address: __________________________________________
__________________________________________
Home phone: (_____) _______________
Student Number: ___________________
Credit hours completed at GRCC: ______________
Cumulative G.P.A. at GRCC: ______________
1) List all LECTURE course(s) taken with me, date taken, and
final grade earned in lecture
(ex. BI 121 lecture – Fall Õ03, B+):
2) List all LAB course(s) taken with me, date taken, and
final grade earned in lab
(ex. BI 121 lab – Winter Õ03, A-):
3) If you had me in BOTH lecture and lab, then what was your
final grade for the entire course?
(ex. BI 121 lecture/lab – final grade of A-):
1) Is there a special form that I need to fill out? Yes or No (Circle one).
If ÒYESÓ, then please attach it to this sheet.
2) Are you going to waive your rights to see the contents of this letter?
Yes or No. (Circle one).
3) What is the purpose of this letter (ex: I am applying to the PT program at GVSU)?
4) Is there anything in particular that you would like me to mention? Explain
5) Is there something that you would prefer that I NOT mention? Explain.
6) What is the due date?