School of Psychology & Counseling

Clergy Recommendation Request Form

Please use the form below to provide Admissions with contact information for your Clergy Recommendation.

  • We will use this information to contact the clergy of your choice and provide them with our Clergy Recommendation Form.
  • You will be notified by email when we have received the completed form. You may wish to contact the clergy separately to let them know about the forthcoming recommendation form.
  • We cannot be responsible for incorrect contact information or unresponsive references, so please follow up with the individuals you have selected to recommend you.
  • Your information (submitted through this form) will be disclosed to the person indicated in this form for the purposes of identification. Do not submit this form if you do not want this information disclosed.
  • Please do not send this form to a family member.
  • If you wish to exchange this type of recommendation for another, please fill out the Recommendation Replacement Form.

*Required for proper form processing

Your full name:*
(use the same name you used on your application)
Your email:* Do not add extra spaces
(use the same email you used on your application)
Your phone number:*
(use the same number you used on your application)
Program you are applying for:*
Are you an international student?*
Name of clergy:*
Email of clergy:* Please ensure you enter the address correctly. Do not add extra spaces
Address of clergy:*
Personal message to clergy:
(optional)

I, the applicant, waive my right to review this recommendation when completed and understand that it will remain confidential.

Yes, I waive this right.  
No, I do not waive this right.
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