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Pre-Health Letter of Recommendation Request Form


Some items marked (*) are optional. All other items are required.
For an FAQ regarding this form, please click here.

Your NetID:

Your Preferred Email Address:

Year of Expected Matriculation:

The Application Service You Are Using for this Application:

*Your Application Service (e.g., AMCAS) ID Number:
[*not necessary for initial request, but must be provided before completed packet will be sent to schools]

*AMCAS LOE Number (only if applying to AMCAS LOE schools):
[*not necessary for initial request, but must be provided before completed packet will be sent to schools using AMCAS LOE system]

Are You Seeking a Campus Letter from Creighton University? (what is this?)Campus Letter No Campus Letter

Do You Waive the Right to Review These Letters in the Future? (what is this?)Yes      No

*Note $20 Fee must be paid in the ARC, Hixson-Lied G06, (or to the PMED Program office for students in the PMED Program) before your completed letter packet will be sent to any schools or application services.

Request Recommendors (minimum of 1, up to 5 maximum [want more than 5?]):
[please note the order in which you enter these recommendors will be the order they appear in the completed packet. Once this order is set, it cannot be changed. Please double-check the order you have indicated below.]

 First NameLast NameDepartmentContact Info (*if not CU Arts & Sciences)
Please fill all items if recommendor is not an A&S faculty or staff member!
Recommendor #1Non-CU Email:
Title (like "Chair of Pathology"):
Institution:
Phone Number (like 402-280-3594):
Recommendor #2Non-CU Email:
Title (like "Chair of Pathology"):
Institution:
Phone Number (like 402-280-3594):
Recommendor #3Non-CU Email:
Title (like "Chair of Pathology"):
Institution:
Phone Number (like 402-280-3594):
Recommendor #4Non-CU Email:
Title (like "Chair of Pathology"):
Institution:
Phone Number (like 402-280-3594):
Recommendor #5Non-CU Email:
Title (like "Chair of Pathology"):
Institution:
Phone Number (like 402-280-3594):