Dietetics Reference Form

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Reference Form

Select Your Program of Interest

Are You A Current EMU Student

Are You Applying to the Online Program? *

Yes

Personal Information

EMU Student ID

First Name

Middle Name

Last Name

Previous Last Name

Cell Phone

Home Phone

Address:

City:

State:

Zip:

Please use your preferred mailing address for which you would like to receive departmental communications.

Under the federal Family Education Rights and Privacy Act of 1974, students are entitled to review their records, including letters of recommendations. The law also permits students to waive this right by selecting to waive his or her rights to inspect the reference letter. Select one option below

I waive my right to review the information provided by the recommenders and will not have access to the information upon request

I do not waive my right to review the information provided by the recommenders and will have access to the information upon request

First Recommender

Name

Email Address

Second Recommender

Name

Email Address

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