Augsburg College faculty and staff are often asked to write letters of reference or recommendation for students to educational institutions, employers, and other organizations. Statements made from the recommender's personal observation or knowledge do not require written release from the student who is the subject of the recommendation. However, if personally identifiable information obtained from a student's education record is included in a letter of recommendation (grades, GPA, etc.), the writer is required to obtain a signed release from the student which: 1) specifies the records that may be disclosed, 2) states the purpose of the disclosures, 3) identifies the entities to whom the disclosure can be made, 4) selects whether to waive or not waive the right to review or receive a copy of the recommendation or reference. The College is not required to maintain a record of each student- initiated request for disclosure of information but recommends that faculty and staff retain a copy of the signed release and letter of reference or recommendation for one calendar year.

Faculty/Staff Member Name: ______________________________________ Date: _____________

Student Name: ____________________________________________________________________

I am requesting that a recommendation letter be released to the individuals/organizations listed below. I agree that the faculty/staff member may draw upon the following information in writing this recommendation.

_____ All personal observations and academic information including grades earned, grade point averages, course work, course performance, other academic and professional interactions, and all other information contained in my academic record.

_____Only personal observations which do not include information from my academic record.

Please send the recommendation to (list individuals or organizations here):

Date of graduation or last attendance: _____________ To be completed no later than: ______________