I hereby request that the Health Professions Committee of Bard College prepare an evaluation on my behalf for my application to the health professional schools I have listed separately. I have also asked members of the faculty of Bard College and others to write letters of recommendation in connection with my applications for health professional schools. I understand that Section 438(a) of the General Educations Provisions Act (Title IV of Pub. L. 93-380.513) gives me a right to inspect and review recommendations written about me which are maintained by Bard College as a part of my “education record.” In order to encourage the authors of letters to write with candor, I have elected not to exercise my rights under the aforesaid statute and affirm I shall not do so in the future.
Further, in accordance with Family Educational Rights and Privacy Act Regulations (FERPA), Electronic Code of Federal Regulations: Title 34, Part 99 I authorize the Bard health professions adviser and other contributors to disclose the following educational records, should it be deemed appropriate to do so: course enrollment information, grade(s), GPA, class rank, written evaluations, honor/awards, and disciplinary action(s). This evaluation is being requested by me for inclusion in my application to health professional schools, and will be used for no other purpose.
