Student Request for Program DirectorLOR, Statement, or Form

Student Request for Program Director

LOR, Statement, or Form

***PLEASE READ ALL INSTRUCTIONS CAREFULLY***

This form is to be used to request a Letter of Recommendation/Reference (LOR), Statement of Good Standing (NOT for clinical sites), completion of certain necessary forms (NOT related to credentialing/licensing), or other documents which are REQUIRED to come from the office of the MEDEX Program Director (PD).

PLEASE NOTE: LOR from PD first drafts will need to be generated by the student/graduate.

GENERIC LETTERS WILL NOT BE PROVIDED.

GRADUATES MUST USE THE LINK BELOW FOR ALL CREDENTIALING-RELATED OR LICENSING-RELATED REQUESTS.

ONE REQUEST PER FORM, please--do not submit multiple requests in one form response.

Please allow a minimum of 2 weeks turnaround time.

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(Graduates, please follow THIS LINK for verifications OR email medxsrvc@uw.edu with questions regarding other needs.)

Name (last, first)*

Email*

(Please only supply your UW email if you are a current student)

Campus/Class*

Please select your campus/class number. If not listed, please enter manually.

Select or enter value

Student Number*

Request Type*

Select

Other Request - Description*

If the selected Request is "Other," please enter here

Purpose*

Select or enter value

Other Purpose - Description*

If the selected Purpose is "Other," please enter here

Required from Program Director?*

Select "Yes" ONLY if specific requirement must be fulfilled by PD. For all other requests, select "No"

Select

LOR Not Required From PD - please read*

If a LOR is not stipulated as being required from the MEDEX PD, students are strongly encouraged to instead seek assistance from their advisors or other appropriate resources, except in cases where no other option is available.

Please check this box to indicate you have read, understood, and accepted the above statement:

Info/Instructions*

Please paste relevant information/link here; attach documents in the next section below. One submission per form, please.

NOTE: A letter cannot be provided without basic information. Please provide a link to program/application, a PDF, or copy/paste relevant information. Contact information such as street address and name + email address for the program and letter/form recipient, respectively, is important to include.

Document Upload*

Please submit your LOR draft here, as well as any supporting documents such as program info/instruction files (if available), your CV, and any other relevant/helpful supporting documents (such as a personal statement submitted with an application).

Drag and drop files here or

Program-Stipulated Due Date*

When is this needed by the program/employer? Please submit all requests a minimum of two weeks prior to this date.

Enter "NONE" if no date given. Please DO NOT supply an arbitrary date, i.e., do not enter a date two weeks from today unless that is the actual stipulated due date.

Notes

Please add any pertinent comments here.

Send me a copy of my responses

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