Registrant's Name
Social Security Number
Has waived right of access to evaluation Has not waived the right of access to evaluation
REGISTRANT must provide all above information including "right of access" choice. (If one of the above has not been indicated, the recommendation will be treated as Confidential.)
TO THE RECOMMENDER: The above-named registrant has established a credentials file with our office and requests your comments to assist in his/her job/graduate school search. These comments will be copied and sent to prospective employers at the registrant's written request. Please us your own letterhead for written comments and attach it to this form. The original copy of your recommendation will be retained for five years in the registrant's file in the Department of English.
NAME AND TITLE
DEPARTMENT AND/OR ADDRESS
SIGNATURE______________________________ DATE__________________________
PLEASE RETURN TO: DEPARTMENT OF ENGLISH CREDENTIALS SERVICE, PO BOX 400121, 219 BRYAN HALL, CHARLOTTESVILLE, VA 22904-4121