East Central University

First Name:

Middle Name:

Last Name:

Date of Birth:

ECU student ID # (If known):

You will need to submit THREE copies of this form (one for each person completing a reference for you). Note: Evaluations should be completed by persons who are able to assess your performance in a professional, educational, or work-related setting.

Once you've submitted this form, your reference will receive an email with the link to complete the reference form.

Reference Information:

First Name:

Last Name:

Employer:

Title:

Phone Number:

Email Address:

The Family Educational Rights and Privacy Act of 1974 entitle student records to be open for students’ inspection. The law also permits a student to sign a waiver relinquishing his/her right to inspect letters of evaluation. Checking the box below constitutes a waiver signifying that the evaluation will remain CONFIDENTIAL, meaning the student will not have access to the evaluation. No check means that the applicant will have the right to read this evaluation.