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 * 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 * Leave this field blank
