This document is a letter of reference request form for Dr. Malott. It requests information such as the applicant's name, contact information, academic performance including GPAs in psychology, math, and writing courses. It also asks for GRE scores, the names and deadlines of schools/programs applied to, research experience, honors received, and courses taken from Dr. Malott including grades. The form provides instructions on including additional materials like a photo, resume, transcripts, and completed forms to be submitted for a letter of recommendation.

1. Letter of Reference Request for Dr. Malott*
*you must indicate that you “waive your right” to access to the letter on relevant forms
NAME (include maiden name):
EMAIL:
Minor / 2nd Major:
# of math courses taken:
# of writing courses taken:
Overall GPA:
PSY GPA:
Minor/2nd Major GPA:
Math GPA:
Writing GPA:
Phone:
Total GRE Score:
Quantitative GRE Score:
Verbal GRE Score:
Analytical Writing Score:
Names & deadlines of the Schools/Scholarships/Fellowships/Jobs, etc. for which you are applying (attach an extra sheet, if necessary):
Additional forms to complete?
Name
Deadline
1)
Yes
No
2)
Yes
No
3)
Yes
No
4)
Yes
No
5)
Yes
No


Electronic Letter?
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
Area of interest (e.g., Autism, DD, I/O, OBM, etc.): _____________________________________________________________ Include a file folder or large envelope
with the following:
Research projects in which you've been involved: _______________________________________________________________

Photo of yourself
_______________________________________________________________________________________________________  Copy of WMU transcript (may be

unofficial)
Honors you've received from the psychology department or university: ______________________________________________  Resume/curriculum vita (CV)
________________________________________________________________________________________________________  Personal statement


Any additional forms (if applicable)
Any additional information: ________________________________________________________________________________  Forms (if applicable), complete
including your signature
Addressed envelopes for letters/forms
(USE 2 STAMPS)
 An optional, self-addressed, stamped
postcard we’ll mail to you when your
letters have been sent
You may also create a zipped folder and
send any of the materials to
Jennifer.L.Mrljak@wmich.edu

Malott PSY Course
Semester
Year
T.A. Name
Grade
3600/1000H
1400
Super A
4600
3570 Regular
3570 Intermediate
3570 Advanced
3980: BRSS
4990: BRSS
Grad/GRE Prep
Self-Mgmt
A
Label folder & turn in at either:



Graduate mailbox “M” in Psych Dept.
(Wood Hall, 3rd floor)
Mailbox “Jennifer Mrljak” or door box
in BATS lab (Wood Hall, 2536)
Mail to: 7535 Timbercreek Ct. #4
Portage, MI 49024
Please allow 4-6 weeks for completion!

2. Letter of Reference Request for Dr. Malott*
*you must indicate that you “waive your right” to access to the letter on relevant forms
Please e-mail Jennifer.L.Mrljak@wmich.edu to notify that materials are complete and have been turned in.