• Letter of Recommendation/Verbal Reference Release

  • The Family Educational Rights and Privacy Act (FERPA) prohibits an educational institution from releasing confidential, non-directory information about a student without the student's consent. A student may waive this right for college officials when written letters of recommendation or verbal references are required.
  • Student:

    Complete this release form to authorize a Rochester University employee access to your education record for the purpose of constructing a recommendation. This form is not a request to provide a recommendation, but permission to use the content of these records. Each employee should be individually contacted to provide a reference.
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  • I authorize the following Rochester University employee to write a letter of recommendation or provide a verbal reference on my behalf:
  • I grant the employee named above consent to provide a letter of recommendation or verbal reference to the following recipient:
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  • I give my permission to include the following non-directory information in a letter of recommendation/verbal reference (check all that apply):

  • The purpose of the information to be released (select all that apply):

  • I understand that (1) I have the right not to consent to the release of my education records for this letter of recommendation; (2) I have the right to receive a copy of this letter upon request unless I waive that right; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to Rochester University to the recipient provided for above, but that any such revocation shall not affect disclosures previously made by Rochester University prior to the receipt of any such written revocation.
  • By checking the box below, I release from all claims and agree to indemnify and hold harmless the individual providing this evaluation, Rochester University, its Board of Trustees, agents, officers, and employees, for any and all direct, indirect, special or consequential damages, or costs, legal and otherwise, for any statements made, consequences realized, or third party actions resulting from such recommendation, written or oral.
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