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Amgen Letter of Rec Waiver

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					                                                      UCLA Amgen Scholars Program
                                                       Letter of Recommendation Waiver Form
Applicant’s Name (first, middle, last)

E-mail Address                                                          Phone Number

Home Institution

Under federal law, students have the right to inspect and review the letter(s) of recommendation contained in their educational
records. However, the applicant may waive the right of access. The letter(s) will then remain confidential between the UCLA
Amgen Scholars Program and the recommender(s). Applicants are not required to waive their right of access as condition for
admission to the UCLA Amgen Scholars Program. All letters of recommendation, whether written confidentially or not, will be
given careful consideration in the admission decision. Applicants alone must decide whether to waive their right of access.

The UCLA Amgen Scholars Program asks that you fill out, sign, and date the declaration below.

Applicant’s Waiver Declaration:
I have read the statements above and I understand that I am not required to waive the right of access under the Family
Educational Rights and Privacy Act of 1974 (“FERPA”) and any/or all other laws, regulations or policies as a condition for
admission to the UCLA Amgen Scholars Program.
Please check the appropriate response.

   I hereby waive my right of access to this letter of recommendation as provided by FERPA
   I do not waive my right of access to this letter of recommendation as provided by FERPA

Signature of Applicant__________________________________________________ Date______________

Your recommender(s) will need to review this waiver form. Please make a copy for your recommender’s
records before you mail this document to the address listed below. If your recommender is not at your home
institution please fax them this document.

Please mail or fax the form to:
                          UCLA, URC/CARE                                         Fax: 310-267-2219
                          Amgen Scholars Program
                          2121 Life Sciences Building
                          621 Charles E. Young Dr. South
                          Los Angeles, CA 90095-1606


                                         Information for Recommender

Instructions to Recommender: Your letter of recommendation needs to be received by Tuesday, February 1, 2011. It
will be helpful to the Amgen Faculty Review Committee and its review process if you discuss the following:
          How long and in what capacity have you known the student
          The student’s motivation for graduate study versus aspiration to attend profession (e.g., medical) school
          The student’s qualifications and potential for research as well as academic success

If there is other information or insights that you wish to share about this applicant, please do.

We ask that you compose your letter on departmental letterhead. Please mail the letter to:
UCLA, URC/CARE
Amgen Scholars Program
2121 Life Sciences Building
621 Charles E. Young Dr. South
Los Angeles, CA 90095-1606

You may also fax your letter of recommendation to 310-267-2219 or email it amgensch@lifesci.ucla.edu.

If you have questions please contact:
UCLA Amgen Scholars Program Administration
amgensch@lifesci.ucla.edu , 310-206-2182

				
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