Letter of Recommendation Form

Form Instruction:

To request a letter of recommendation, please complete the following steps:

1. Personal Information & Academic Details: Gather your college transcript (to provide your science GPA, overall GPA, and chemistry courses/semesters you took with me). Attach your updated resume/CV to help me tailor your letter.
2. Institution/Scholarship Details: For each institution or scholarship (up to 3 max), provide:
   1. Institution/program name
   2. Whether the letter is for acceptance, scholarship, or both
   3. Contact information and any URLs provided by the program
   4. Add any relevant emails in the paragraph at the bottom of page 2.
3. Centralized Application Systems: For health professional programs (e.g., AMCAS for medical schools, AADSAS for dental schools, PharmCAS for pharmacy schools), you only need ONE letter from me. These services streamline the process, sending a single application to multiple schools.

Tips for Success:

• Fill out the form carefully and provide accurate, detailed information.
• The more information you provide, the better I can tailor your letter.
• If you have questions about your GPA, identifying courses, or centralized systems, don’t hesitate to reach out.

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– Step 1 of 3

About You

– This section is required to help me personalize your letter. –  Submit your request at least 2-3 weeks before the deadline otherwise I cannot guarantee it will arrive on time.

Preferred Name *

First

Last

Preferred Email *

Email

Confirm Email

So I can contact you regarding completion of your request.

Preferred Gender Pronouns *

• He/him/his
• She/her/hers
• They/them/their:

Aids me in tailoring the letter to express who you are.

Science GPA *

Classes you completed with me. (Check all that apply). *

• Chem 103/1405
• Chem 121/1411 (Lecture)
• Chem 122/1412 (Lecture)
• Chem 121L/1411L (Lab)
• Chem 122L/1412L (Lab)
• Organic Chemistry

What semester(s)? *

Estimate your rank in the course – Chem 103/1405 *

• Top 5 % – A
• Top 10 % – B
• Top 25 % – C+
• Top 50 % – C

Use your letter grade in the course.

Estimate your rank in the course (copy)- Chem 121/1411 *

• Top 5 % – A
• Top 10 % – B
• Top 25 % – C+
• Top 50 % – C

Use your letter grade in the course.

Estimate your rank in the course – Chem 122/1412 *

• Top 5 %
• Top 10 %
• Top 25 %
• Top 50 %

Use your letter grade in the course.

Estimate your rank in the course – Organic *

• Top 5 %
• Top 10 %
• Top 25 %
• Top 50 %

Use your letter grade in the course.

Did you work on undergraduate research with me? *

• Yes
• No

If you answered YES, please provide your research project title. *

Currently or recently degree seeking (undergraduate)? *

• Yes
• No

Intended Major *

Overall GPA *

Upload your CV/Resume *

Click or drag a file to this area to upload.

Tell me anything else that I should put on your letter to make you look good and stand out. (Optional)

Next

About Institution

Please complete this section with information about the institution(s) you plan to attend. If you are applying through a centralized clearinghouse (e.g., AMCAS for medical school), you only need one letter, as it will be sent to all the schools you select through their service. If you are applying directly to an institution or for a scholarship, please provide the necessary links and mailing addresses for submission.

Intended Degree Plan— Select Program —Medical School (M.D./D.O.)Pharmacy School (Pharm.D.)Dental School (D.D.S)Veterinary School (DVM)Physical Assistant/Nurse Practitioner (PA/NP)Nursing School (ADN/BSN)Scholarship

Are you applying for a scholarship in addition to acceptance?

• Yes
• No

Do you need additional letters?

• Yes
• No

How many letters do you need? (Max: 3)123

Institution Name #1 *

Please provide the name of the institution.

Institution #1 LORE Due Date

Provide the due date when this institution needs this letter please allow a minimum of 2-3 week to complete.

Recommendation Letter Contact #1

First

Last

If no contact or applying to a department/school leave blank.

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Provide the address of the person or place this letter should go.

Institution URL #1 *

Please provide the link of the institution or clearinghouse information (e.g. AMCAS link).

Phone *

Provide a contact number should there be an issue with your letter.

Institution Name #2 *

Please provide the name of the institution.

your good me?

Institution #2 LORE Due Date

Provide the due date when this institution needs this letter please allow a minimum of 2-3 week to complete.

Recommendation Letter Contact #2

First

Last

If no contact or applying to a department/school leave blank.

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Provide the address of the person or place this letter should go.

Phone *

Provide a contact number should there be an issue with your letter.

Institution URL #2 *

Please provide the link of the institution or clearinghouse information (e.g. AMCAS link).

Institution Name #3 *

Please provide the name of the institution.

Institution #3 LORE Due Date

Provide the due date when this institution needs this letter please allow a minimum of 2-3 week to complete.

Recommendation Letter Contact #3

First

Last

If no contact or applying to a department/school leave blank.

Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Provide the address of the person or place this letter should go.

Phone *

Provide a contact number should there be an issue with your letter.

Institution URL #3

Please provide the link of the institution or clearinghouse information (e.g. AMCAS link).

Contact Email(s) & Anything else you think will aid me.

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