Instructor 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

Student Information

First Name

Last Name

Maiden Name

Student ID

Program

Graduation Date

Contact Information

Phone Number

Email Address

Reference Release Information

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

Instructor Name

Instructor Email Address

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Instructor Release Form

Student Information

Contact Information

Reference Release Information

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