Reference Form for Graduate Application
reference form for Graduate application under the family educational Rights and privacy act of 1974, a student enrolled at virginia tech has access to his or her academic records. We comply with this law, while still allowing the option of waiving the right to access this specific document. Waiving this right does not preclude you from access to the rest of your academic records. You may sign below to waive your right to have access to this document. Your choice will not affect the consideration of your application to virginia tech.
appliCant to Complete
laSt/familY name
fiRSt/Given name
middle name
Suffix
Student id number: if known
desired program
degree desired
□ Doctoral □ EDucation SpEcialiSt □ MaStErS □ GraDuatE cErtificatE year □ non-DEGrEE □ coMMonwEalth caMpuS
date of Birth: month/day/year e-mail address:
@vt.edu account, preferred
first term of enrollment desired
□ fall □ SprinG □ SuMMEr i □ SuMMEr ii
daytime phone: local address
□ home □ office □ Mobile
campus
□ BlackSBurG □ haMpton roaDS □ national capital rEGion □ richMonD □ roanokE □ SouthwESt VirGinia □ Virtual
city
state
zip
country
appliCant SiGnatuRe
date
Applicant: Please provide the mailing address of the department to which you have applied to assist your reference.
reference: please return this completed form to the following department:
reference to complete name: address
RefeRenCe to Complete
title: School/company: city state zip country
daytime phone:
e-mail address:
if available, provide the applicant’s relative standing in your department. how would you rate this applicant in overall ability and promise in comparison with others at the same level of training? top 1% to 2% 3% to 5% 6% to 10% 11% to 25% 26% to 50% beloW 50%
Give your opinion of the applicant’s academic and research abilities, providing examples where appropriate. please indicate how long you have known the applicant, and in what
appliCant to Complete
laSt/familY name
fiRSt/Given name
middle name
Suffix
Student id number: if known
desired program
degree desired
□ Doctoral □ EDucation SpEcialiSt □ MaStErS □ GraDuatE cErtificatE year □ non-DEGrEE □ coMMonwEalth caMpuS
date of Birth: month/day/year e-mail address:
@vt.edu account, preferred
first term of enrollment desired
□ fall □ SprinG □ SuMMEr i □ SuMMEr ii
daytime phone: local address
□ home □ office □ Mobile
campus
□ BlackSBurG □ haMpton roaDS □ national capital rEGion □ richMonD □ roanokE □ SouthwESt VirGinia □ Virtual
city
state
zip
country
appliCant SiGnatuRe
date
Applicant: Please provide the mailing address of the department to which you have applied to assist your reference.
reference: please return this completed form to the following department:
reference to complete name: address
RefeRenCe to Complete
title: School/company: city state zip country
daytime phone:
e-mail address:
if available, provide the applicant’s relative standing in your department. how would you rate this applicant in overall ability and promise in comparison with others at the same level of training? top 1% to 2% 3% to 5% 6% to 10% 11% to 25% 26% to 50% beloW 50%
Give your opinion of the applicant’s academic and research abilities, providing examples where appropriate. please indicate how long you have known the applicant, and in what