UNIVERSITY OF NORTH ALABAMA 
STUDENT REQUEST FOR LETTER OF RECOMMENDATION, EVALUATION OR OTHER RELEASE OF INFORMATION
AND 
FERPA RELEASE 
Student name (please print): ___________________________________________________

Student Identification Number: _________________________________________________

I request ___________________________________________ to: (check all applicable spaces)

__________ write a letter of recommendation
__________ complete an evaluation form
__________ release information verbally
__________ other (specify) _____________________________________________ 

The purpose(s) of this request are: (check all applicable spaces)

_________application for employment
_________ scholarship or honorary award
_________admission to another education institution
_________ other (specify) _____________________________________________
			
The disclosure is to be made to: (check all applicable spaces)

_________ All prospective employers OR
_________ All educational institutions OR
_________ All organizations considering me for an award or scholarship OR
_________ Only to the following:     _______________________________________ (specify)
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				      _______________________________________	
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I authorize the above person to release information and provide an evaluation or recommendation about any and all information from my education records at the University of North Alabama (“University”), including information pertaining to my GPA, grades, courses, performance, class rank and my education at other institutions I have previously attended which is a part of my education records at the University, deemed necessary by said person to comply with the above request. 

I understand further that: (1) I have the right not to consent to the release of my education records; (2) I have a right to receive a copy of any written reference, letter of recommendation or evaluation form upon request unless such right is waived below; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to the University, but that any such revocation shall not affect disclosures previously made by the University or prior to the University’s receipt of any such written revocation.

I waive (      ), do not waive (     )  - check one – my right to see the recommendation or other information prepared pursuant to this release now or in the future. 

_____________________________________		____________________
Student's Signature					Date