To be completed by the applicant before recommendation is given to referee.

I am requesting a letter of recommendation from ___________________________________ which is to be added to my academic dossier with the Graduate Program in Computer Information Science, La Salle University.

As per my rights under the U.S. Family Educational Rights and Privacy Act of 1974:

____ It is my desire that this letter be CONFIDENTIAL and I wish to waive my rights of access to this letter, once received by the Graduate Program.
____ It is my desire that this letter be NON-CONFIDENTIAL, and I wish to retain my rights of access to this letter; the statement is to be so designated by the Graduate Program.

Applicant's Signature_______________________________________ Date_______________

Instructions to Writers of Professional References

______________________________ is applying for admission to the Graduate Program in Computer Information Science at La Salle University.

The candidate has indicated above whether this reference is to be CONFIDENTIAL or NON-CONFIDENTIAL: a non-confidential reference will be so designated by the Graduate Program and may be shown to the candidate. Do not make any statements until the applicant has completed the above portion of this form.

When completed, please return to:
LA SALLE UNIVERSITY GRADUATE PROGRAM IN COMPUTER INFORMATION SCIENCE, Box 267 1900 W. OLNEY AVE. PHILADELPHIA, PA 19141-1199
TELEPHONE: (215) 951-1222 FAX: (215) 951-1805

___________________________________________ is applying for entrance to the Graduate Program in Computer Science. He/She has submitted your name. Would you please take a few minutes to fill out this form and mail it to the above address?

How well do you know the applicant? (Please check appropriate space)

_____I spend a good deal of time with the applicant and know him/her well.
_____I have a fair amount of contact with the applicant.
_____I see the applicant enough to give some valid impressions.
_____Other (Please explain) Please write a recommendation in the space below or on a separate letter. We are particularly interested in the applicant's aptitude for graduate study in Computer Information Science and his or her ability to relate effectively with people:

Printed name_______________________________________________________

Daytime Telephone Number___________________________________________

Signature_________________________________________ Date____________

Title or Position_____________________________________________________