ࡱ>  0$bjbj `F4= 778?$ce 5555$g" % ~@ 7755I ZZZ755ZZZ6Z5ТzjZ5 0e Z%j%ZZ&%PZ Ze % :  SHAPE \* MERGEFORMAT  Recommendation Request Form Department of Psychology Name: __________________________________ E-mail: ________________________________ Telephone: _______________________________ HUB box:______________________ Or address: _________________________________________________________________________________ I request that Professor Suman Ambwani provide recommendations for me. I consent to the release of any and all information about me in Professor Ambwanis possession. I give my permission for Professor Ambwani to provide a candid recommendation based on her overall knowledge of me from formal and informal observations, formal and informal records, personal and second-hand knowledge, and all other sources. I give Professor Ambwani permission to provide a recommendation for me to any and all sources that may request it until such a time as I notify Professor Ambwani in writing that this permission has been revoked. Signature: _______________________________________ Date: _______________________ To enable Professor Ambwani to provide a complete and thorough recommendation, you must create a packet of information containing the items listed below. As you collect each piece of information, check the line next to the item. Once everything is collected, provide all of it, along with this form, in a large envelope to Professor Ambwani. _____ Recommendation Request Form _____ List of all psychology courses taken or enrolled in (see reverse). _____ Current GPA and psychology GPA (see reverse). _____ Current transcript. _____ A written statement summarizing your strengths and weaknesses. (Be honest with this.) _____ A written statement summarizing your activities, interests, and past employment history. _____ A list of schools, employers, etc. to whom you would like a written recommendation sent. You must use the attached form and include addresses and due dates. _____ An addressed and stamped envelope for each recommendation requested _____ If there are forms from graduate schools that must be completed and mailed with the letters of recommendation, provide each form with all the pertinent information, including your signature, completed. _____ If you must submit a personal statement with your application, provide a copy of that statement. _____ If you have a rsum, provide a copy of that rsum (or CV) _____ A table summarizing graduate schools and due dates _____ A summary of your involvement/interactions with me. Name: _______________________________________ Psychology Courses TakenGrade EarnedInstructorNon-PSYC but Relevant CourseworkGrade EarnedInstructor  Name: ____________________________________ Please be sure to give us the complete address of the school to which your letter is to be mailed even if the letter is being returned to you in a self-addressed envelope. Address :_____________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online formAddress :______________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online form Address :______________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online form Address :______________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online formAddress :______________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online form Address :______________________________________ _____________________________________________ _____________________________________________ _____________________________________________ _____________________________________________ Name of program to which you are applying: _____________________________________________ Due Date: ____________________________________ ( Send directly to above address in stamped, addressed envelope I have provided. ( Return to me in self-addressed envelope I have provided. ( Online form. Application Summary Page Grad SchoolProgram AreaDegree (M.A./M.S./Ph.D./Psy.D/Other)Research areaAddress letter to anyone in particular?Supplemental Rec form?Send to (you/career center/online)Due date (for Prof Ambwani to submit)(Example) Texas A&M Univ  Clinical Ph.D. Eating Disorders, Personality Ax No No Career Center Dec.1          Involvement/Interactions Summary Please indicate the various ways in which we have worked together be as specific as possible. For instance, if you worked as a research assistant, you might list specific research tasks and projects we worked on, and list conference presentations/manuscripts that resulted from this work. If you worked as a teaching assistant, describe the tasks that you were involved with e.g., grading exams, reviewing research proposals, and so forth. 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