University of Utah Le er of Recommenda on

Permission to Release Educa on Record Informa on

Please submit this form to the individual who you have requested the Le er of Recommenda on from.

Merritt Grace Lebrecht u1121064
Student Name: _________________________________ Student ID Number: ____________________

Steven Bell
I authorize ________________________________________ to write a le er of recommenda on on my behalf to:

Recipient Name UMass Boston Graduate Admissions

PO Box 6195 Bustleton Avenue
Address Philadelphia, PA 19115

Phone number 617.287.6400

Email graduate.admissions@umb.edu

The following informa on may be included in the recommenda on le er (mark all that apply):

Grades Courses A ended

GPA Academic Performance
Class Rank Other: _________________________________________

Check one:( I waive I do not waive) my right to review a copy of the le er at any me in the future.

3/12/21
Student Signature Date

Note: please assist the faculty member in preparing your reference by providing suppor ng informa on along with your request.
Examples of informa on that might be helpful: a resume, a transcript, samples of previously completed academic work, etc. and informa on
about the graduate program or posi on for which you are applying.

This form is being provided to assist you and your faculty in the permission process for student recommenda ons and references. The form
has been dra ed using the sample le er provided by the American Associa on of Collegiate Registrars and Admissions Officers (AACRAO)
and complies with the Family Educa onal Rights and Privacy Act (FERPA) which requires wri en permission before releasing student
informa on to a third party.

It is recommended that this release be kept on file for at least one (1) year. If you have ques ons concerning the confiden ality and
release of student informa on, please contact the Registrar’s Office at (801) 58 - or by email at registrar@utah.edu.

Updated: / /201