Educational Placement and Career Services

							INSTRUCTIONS FOR COMPLETION OF REFERENCE FORM
TO THE CANDIDATE: 1. Type your name, major, and file number (if known). If the writer is not on campus, you must provide a stamped envelope addressed to the Educational Placement and Career Services office. 2. Save the document, giving it an appropriate file name. 3. Send the document digitally to the writer. This can be done by attaching it to an e-mail or by storing it on a flash drive or disk where the file can transported to and saved onto the writer’s computer. TO THE WRITER: 1. COMPLETE THIS FORM ONLY IF YOU HAVE BEEN REQUESTED TO DO SO BY THE CANDIDATE. 2. Under the Family Educational Rights and Privacy Act of 1974 (Buckley Amendment), the candidate is entitled to review this reference or to waive the right to access. If the candidate has not waived his/her right to access, we will provide the candidate with a copy stamped "Campus Copy." 3. IF MORE SPACE IS NEEDED, USE A SEPARATE SHEET OF PLAIN PAPER. 4. PLEASE BE SURE TO SIGN THE EVALUATION BEFORE RETURNING IT. 5. Only the ORIGINAL of this reference will be accepted by Educational Placement and Career Services, and it becomes the property of EPCS and the University of Wisconsin-Madison when it is received. 6. Computerized references a. Type directly onto the reference form. Type identification information on top (if not done by candidate) and bottom, and, once the form is complete, save and print it. **Be sure to sign your name (use black ink). b. If you feel you cannot print the information on this form, use letterhead from your school and/or department or business. Be sure to sign the letter.

DO NOT USE THIS PAGE

Educational Placement and Career Services University of Wisconsin-Madison

B150 Education Building 1000 Bascom Mall Madison, Wisconsin 53706

Reference: EVALUATION OF PROFESSIONAL COMPETENCIES
(To be used only for employment purposes or admission to Graduate School)

Name of Candidate Major

File No.

Click here to type text.

Name of Writer Title/Dept. School or Business

Signature of Writer ____________________________________ Phone Date Address City State Zip
RETURN THIS ORIGINAL DIRECTLY TO EDUCATIONAL PLACEMENT & CAREER SERVICES. DO NOT GIVE IT, OR A COPY OF IT, TO THE CANDIDATE. THIS REFERENCE IS OFFICIAL ONLY AS PART OF THE EDUCATIONAL PLACEMENT & CAREER SERVICES CREDENTIAL.