Student Waiver Form

To the Applicant: Please complete this form and submit.

Name of Applicant(Required)

First Last

Phone #(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Social Security #(Required)

Program of Interest(Required)

Notice:(Required)

PUBLIC LAW 93-380, the Family Education Rights and Privacy Act of 1974, grants all students the right to inspect and review all of their official records. This right extends to letters of recommendation, except that a student may waive his/her right to inspect and review letters of recommendation by signing a waiver.

I waive my right to review this reference form

I do not waive my right to review this reference form

Signature(Required)

Date(Required)

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