TechConnect Reference Release Form

TechConnect Reference Release Form

You are hereby granting the instructor named on this Reference Release Form permission to discuss your abilities and qualifications for employment with prospective employers.

You may revoke this authorization at any time by written request.

Please be aware that a copy of this reference release form will be e-mailed to:

• Career Services Office
• The instructor or staff listed on the form
• Student/Graduate

*Required Fields

Student Information

*First Name

*Last Name

Maiden Name

*Student ID

*Program

*Graduation Date

Contact Information

*Phone Number

*Email

Reference Release Information

I hereby grant (instructor name) permission to discuss my abilities and qualification for employment with prospective employers.

*Instructors Name

*Instructors Email Address