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Gathering and Submitting Letters of Recommendation

(Guidelines for pre-OT, PT, and PA students)


Start By Reading This

This page provides tips and guidelines to help future OT, PT, and PA applicants manage the process of gathering letters of recommendation. (Within this context the terms letters of recommendation, letters of reference, recommendations, and references all mean the same thing.)

We encourage you to come in for an appointment to discuss your particular circumstances and progress! Simply click the Make An Appointment link on the HPPLC homepage and follow the simple instructions.


Note: Recommendation services such as Interfolio are not currently compatible with the OT, PT, and PA central application services (CAS) - OTCAS, PTCAS, CASPA. Some future applicants may still use Interfolio as an option to keep their letters safe in one place during the months or years leading up to the application; for example, a pre-PA student who may be deferring the application while garnering direct patient care experience. Others instead ask recommenders to please keep the letter until it is time to apply, perhaps also asking for a hard copy in a sealed / signed envelope just in case.


If you are pre-OT, PT, or PA and choose to use Interfolio, please note:

  • Only recommenders can upload and download letters from Interfolio;
  • Because Interfolio cannot interact with OTCAS, PTCAS, or CASPA, recommenders would still need to upload letters themselves to the given CAS after you open your central application (Interfolio may be compatible with some non-CAS program applications);
  • Again, Interfolio would be serving as an optional repository to keep your letters safe in one place.


To learn more about Interfolio, including tips and instructions for using the service, click HERE.


Whether you are communicating with an administrative assistant, a receptionist, a faculty member, or an admissions representative, always be perfectly polite and professional in all interactions, with everyone! Not only is such conduct critical in terms of your own developing professionalism, but we know of applicants who have had a recommender rescind their agreement to write a letter and other applicants whose application has been tossed into the "Denied" stack due to a single presumptuous or discourteous phone / email interaction.


Central Application Service And Non-Central Application Service Programs

Some professional programs require that you apply through a central application service, or CAS - e.g., CASPA for physician assistant, PTCAS for physical therapy, OTCAS for occupational therapy - whereas others require that you apply directly to the program itself instead of through a CAS. If you are applying to both CAS and non-CAS programs, your letters of recommendation will need to submitted in more than one way.


Whether or not a program partners with the central application service has absolutely no bearing on program quality or accreditation; it is simply a choice they've made about their application process. About 20% of PA, 30% of PT, and an even greater percentage of OT programs choose not to use the given CAS. Therefore, please do not make the mistake of overlooking non-CAS programs. Consult the official and complete lists of all OT, PT, and PA programs, linked from the Researching Accredited Programs page.

How to submit letters

CAS programs

In addition to thoroughly reading the information and tips here, be sure to frequently consult the FAQs and application directions on the CAS sites, including those specifically about submitting letters. These processes are very clearly explained in each CAS. In essence, once you open an application with the given CAS, you will enter contact information for your recommenders, who will in turn receive an email from the CAS telling them how to access your application to upload their recommendation.


After you've consulted instructions and FAQs, feel free to call the CAS directly if you still have questions about filling out the application. (Remember: CAS customer service representatives are not preprofessional advisors or application consultants. You should only ask them technical questions about their website or how to fill out the application itself.)


Non-CAS programs

Consult the websites of non-CAS programs to determine not only what kinds of letters they require or prefer, but also how they want them submitted. Provide your recommenders with detailed instructions. Feel free to contact programs if you need clarification.


Central application service sites

At the appropriate site below read the FAQs and instructions pertaining to letters / references:

Some additional points to bear in mind from the start

  • Different programs require different letters. Some may require one from a practicing professional in the given field; some may prefer two. Some may specifically require or strongly prefer at least one letter from an upper level prerequisite instructor, or from someone who has supervised you in a work, volunteer, or similar setting. Confirm with each program what letters they require or prefer.

  • Generally, each recommender should write only one letter. It is usually not a good idea to ask your recommenders to write a letter for each program to which you plan to apply. It is not even possible to submit different letters to different schools through the various central application services. Furthermore, if you are applying to non-CAS programs, having multiple versions of a letter from the same recommender increases the chances of errors.
  • Each non-CAS program will have its own application. Some are paper, some are electronic; some require electronic submission of letters, some still require paper hard copies of letters.
  • Related to the above point, most central application services, and many non-CAS programs, require that applicants and/or those writing letters of recommendation use forms that are unique to the CAS, or to the non-CAS program. They are usually electronic forms that are filled out on the CAS or non-CAS program website, or forms that are downloaded and printed.
    • Therefore, many programs and central application services will not accept letters of recommendation or evaluations which are not submitted with the correct, unique form.
  • You may find yourself applying simultaneously to both CAS and non-CAS programs, and that is fine. In that situation, you will keep track of two or more letter submission processes, being sure to explain these processes clearly and thoroughly in an email to your recommenders.


Who To Ask

First, remember that people are under no obligation to write letters of recommendation. They are doing you a service, so always be polite, professional, concise (but thorough) in your communications, and give them plenty of time to write the letter - a few months if at all possible. A couple of weeks is not enough time.

Letter requirements vary by program

As you begin to research programs, and, subsequently, to gather letters, check program websites and the CAS site to learn which programs have specific requirements or preferences with regard to who they want letters from - how many from healthcare practitioners, what kinds of letters from instructors, and so on. For programs with no stated preferences, you should consider in any case including among your letters one from a licensed professional in your field of interest, usually one with whom you have done extensive clinical observation.

Licensed healthcare practitioners

Most graduate-level professional programs either require or recommend that one or more of your letters come from a licensed practitioner within the given field, be it OT, PT, or PA. Therefore, undertake extensive and ongoing clinical observation (i.e., shadowing) with a variety of professionals within your field of interest, and preferably within a variety of settings. Ask for a letter from one or two practitioners with whom you've established an excellent rapport, and who you think can best speak to your enthusiasm for and interest in the field, your professional conduct, and so on. Even if none of your programs require a letter from a practitioner in your field of interest, you should still include one with your application.


Programs will accept letters from either teaching or research faculty. If at all possible, try to gather at least one letter from a 200-400-level prerequisite instructor. Some programs will require the latter, and some will specifically want a letter from a science prerequisite instructor.

In a more general sense, consider gathering letters from upper level course instructors from whom you have earned strong grades (an A- or higher, if possible), and with whom you have established an excellent rapport. These instructors can best speak to your academic abilities. Low-level general education courses are sometimes okay, but not usually preferred. Furthermore, upper-level courses are often smaller and more focused, and therefore can sometimes result in stronger letters if you have taken the time to help your instructor get to know you. (See next section for further ideas.)

Most programs appear to be fine with letters from associate instructors, but check ahead of time to make sure they will look upon a strong letter from an AI as favorably as they would a strong letter from a faculty member. If yes, then ask the AI if he or she could ask their faculty supervisor to co-sign the letter. In paper letters, the supervisor signs the letter, with his or her title, beneath the signature of the AI. In the case of electronic letter submissions, it's usually okay for the faculty supervisor's name and title to appear beneath the AI's electronic signature line.

Other references

For many programs it is acceptable (and occasionally preferred) that you include a letter from a work, internship, or volunteer supervisor. Check with individual programs for related policies.


How To Ask

Take the direct but polite approach

First, establish a good rapport with:

  1. An instructor (through office hour visits, chatting before and after class, being an excellent and consistent participant in class discussions, doing well academically in the class). Whether this letter should come from a science, other prereq, or upper-level course depends on your programs. Check their requirements.
  2. A professional within your field of choice (through substantial clinical observation, asking thoughtful questions about the profession and their role within it, conducting yourself in a thoroughly professional manner).
  3. And, oftentimes, a work, internship, or volunteer supervisor.


If you have not been earning many grades in the A-range, and feel you therefore have limited academic letter options, then have a conversation with those instructors with whom you have established the best rapport. Ask if they would be willing to write a letter on your behalf, and whether they believe your performance and/or the grade you earned would severely hamper their ability to write a genuinely strong letter.


Once you have established a good rapport over time, simply ask them," Do you feel you would be willing and able to write a supportive letter of recommendation on my behalf for professional programs?" There is no need to beat around the bush or be coy when asking for a recommendation. Just be polite, professional, and undemanding.


If they agree, give them a specific time by when it would be helpful for them to have the letter written. Optimally, the date you give them is a couple of weeks prior to when you plan to submit the application. Let them know that, closer to the time of the application, you will supply them with details for how to submit the letter to both central application services and any non-CAS programs.


If they hesitate or decline

If they seem uncertain, tell them it's okay for them to be frank with you - whether they simply don't have time, don't feel they are the best person to advocate on your behalf, or something else. In such cases, or if they simply decline, politely thank them for their time and move on to other letter options.

  • The "pester approach" is a very bad strategy. Don't ever pressure or plead with someone to write a letter if they've declined, seriously hesitated, or suggested you ask someone else!
  • If you are asking just a few weeks before you need the letter, remember that you are asking them for a big favor. Act accordingly - with deference and humility. The "Don't pressure them" point noted above goes double if you are asking less than eight weeks ahead of needing the letter. Optimally, you should allow recommenders at least two months to write the letter, if not longer.


What information to provide your recommenders

Information about you

  • A draft of your most recent résumé or CV. (The CV format includes more detail than a résumé, and is common to academic settings.)
  • A list of your clinical observation experiences, volunteer experiences (especially those related to your professional area of interest), and any hands-on direct patient / client care experience you have. (This information might instead be included in the résumé or CV).
  • A draft of your personal essay, if you have one.
  • If you don't yet have a solid draft of your personal essay, then it's a good idea to provide recommenders with a few paragraphs explaining why you are interested in the profession, and what your professional goals are.
  • Along these lines, and again, if you don't yet have a personal essay daft: As explained on the HPPLC Clinical Observation page and in the Guidelines for Hands-On and Direct Patient Care Experience, it is a good idea to include specific details about a few particular interactions you yourself have had with a given healthcare professional in your field, or with a patient / client - moments which impacted your decision to pursue the profession, which offered you important insight into the profession, or which taught you something about yourself in relation to your professional goals.
  • In short, provide your recommenders with anything you believe will give them additional insight into your goals, abilities, attributes, relevant experiences, and your devotion to the profession you've chosen to pursue.

Information about forms and letter submission instructions

IMPORTANT: In relation to both CAS and non-CAS programs, provide each your recommenders with an email that includes extremely detailed, clear, step-by-step instructions for how they will submit the letter of recommendation. Recommenders should not have to hunt around for instructions and links, and any unclear steps for a given program should be figured out by you ahead of time (call the CAS or the given program if need be) and explained in your email to the recommender.


If you already know where you are applying:

  • CAS programs require or prefer recommenders to submit electronic letters or applicant evaluation forms. Before you enter their information into the CAS be sure to let your recommenders know to expect an email shortly from the CAS, because as soon as you enter their contact information into the central application, or at most within 24 hours, the CAS will email your recommenders a link to the letter portion of your application, and related online forms. Again, they are contacted almost immediately, and not after you submit the entire completed CAS application itself.
  • For programs with electronic forms - whether CAS or non-CAS programs - you could let recommenders know that when you get closer to actually applying, you will provide them with the information they will need to submit letters to particular programs. However, if you are already in the process of filling out applications, provide them with related information right away.
  • You might check to see if any of your CAS or non-CAS programs require recommenders to complete a specific hardcopy recommendation form and / or applicant evaluation form. If so, you could provide your recommenders with any hardcopy forms they will need to complete for a given program. (Assuming these programs also require a hardcopy application, you yourself will likely submit the completed recommendation forms along with your application. For more details, refer to Managing The Process Of Gathering And Submitting Recommendations.)

If you are not sure where you are applying, don't worry for now, as you can always provide any additional forms and directions to your recommenders as you get closer to applying. You'll find more information about applicant evaluation forms further along on this page.



When To Ask

Give recommenders months, not weeks

Optimally, you should ask for letters a minimum of two or three months before you need them. The people you are asking have a lot on their agendas besides recommendations; you want to give them adequate time to be thoughtful about what they say on your behalf, and out of general courtesy. It is not uncommon for preprofessional students to gather most of their letters during the year before they apply. It is uncommon, though not unheard of, for freshmen to gather a letter.

Note that central application services recommend that applicants submit their completed application, including all recommendations, several weeks before program deadlines in case something is missing or incorrect. Bear this timing in mind as you gather letters.

Ask sooner rather than later

Here is another way of looking at it: Once you've established a good rapport with the person from whom you wish to request a letter, it's usually best to ask them right away, even before the class, clinical observation, or other experiences has concluded, instead of waiting. This way, you are more fresh in their mind, and they will likely be thinking of your future interactions within the context of the letter they are going to be writing. If you are certain you will be taking another class with the same instructor, or will be undergoing more clinical observation with the same healthcare professional, you could ask them to wait and write your recommendation after that experience, at which time you will know each other even better - that is, if there would still be adequate time prior to your application.

Last minute emergency requests

It is rarely the case that it is not possible to give someone a couple of months to write a letter. If such a situation does arise, briefly explain the circumstances, be apologetic about the short notice, and ask if they would have time to write a supportive letter in the time you have. If they hesitate, or say they can't promise, you may need to figure out something else.


Managing The Process Of Gathering And Submitting Recommendations

General tips and suggestions for both CAS and non-CAS programs

Important additional information

Always be perfectly polite with everyone

  • Whether you are communicating with an administrative assistant, a receptionist, a faculty member, or an admissions representative, always be perfectly polite and professional in all interactions, with everyone. Not only is such conduct critical in terms of your own developing professionalism, but we know of applicants who have had a recommender rescind their agreement to write a letter, or whose admission has been denied due to a single presumptuous or discourteous phone / email interaction.

Provide your recommenders with detailed instructions

  • Even if you inform a recommender verbally about the submission process(es), follow up with an email in which you clearly explain in bulleted, point-by-point detail any and all submission procedures (including those related to any applicant evaluation forms your recommenders must fill out) for both CAS and non-CAS programs - every single step recommenders must take for each submission: "First, follow this link. Next, do this. Then do this." They should not have to hunt around for information or try to figure things out for themselves.
  • Provide recommenders with the contact information for the central application service and for any non-CAS programs, as well as with the email address and phone number at which you can most easily be reached.
  • Keep in touch with your recommenders regarding any new information or directions you learn which are germane to their role in the recommendation process. Review the How To Ask section.

Allow recommenders plenty of time to write letters

Give recommenders a soft deadline

  • Once someone has agreed to write you a letter of recommendation, give them an idea of when you need the letter. If possible, you might give them a date that is a couple of weeks prior to when you absolutely must have the letter, thus leaving some leeway in case something unexpected arises.

Keep your letters safe

  • Recommendation services such as Interfolio are not currently (as of 2016) compatible with the OT, PT, and PA central application services (CAS) - OTCAS, PTCAS, CASPA. Some future applicants may still use Interfolio as an option to keep their letters safe in one place during the months or years leading up to the application; for example, a pre-PA student who may be deferring the application while garnering direct patient care experience. For additional information about Interfolio, click HERE.
  • Other future applicants instead ask recommenders to please keep the letter until it is time to apply. In this case you could ask if they could provide you with a hardcopy of the letter once it's written. If you decide to do so, you would give each recommender an envelope with both your name and their name on the outside ("Letter of recommendation for _______, by _______"), and ask them to insert a copy of the letter, seal the envelope and sign their name across the flap. This way, you too will have a back-up copy, while still maintaining the privacy of the letter.

Sending recommenders a courteous update, but not constant reminders

  • Assuming you have given your recommenders at least two or three months to write your letters as we strongly suggest (or have made other arrangements with them) and have told them by when you need the letter, it is advisable to send them a courteous "touching base" email a couple of weeks prior to when you need the letter. However, do not send repeated reminders or enquiries about their progress. Pestering recommenders is discourteous and could have a negative impact on their evaluation of your professionalism and maturity. If you have concerns then perhaps an in-person touching base would be helpful to gauge the situation.

One letter from each recommender

  • Generally, each recommender should write only one letter. It is usually not a good idea to ask your recommenders to write a letter for each program to which you plan to apply. It is not even possible to submit different letters to different schools through the various central application services. Furthermore, if you are applying to non-CAS programs, having multiple versions of a letter from the same recommender increases the odds of errors on the part of both you and your recommenders; for instance, sending the wrong letter to the wrong program. Having multiple versions also creates more work for you and your recommenders, with little or no substantial payoff. (Note, however, that different programs may require that recommenders complete different applicant evaluation forms - see below.)

Electronic versus paper submissions

  • Ask your recommenders to submit letters and evaluations electronically for those programs and services which offer or require electronic submission. Compared to hardcopy submissions, electronic letter submission is always easier and faster for everyone involved.

Applicant evaluation forms

  • In addition to the letter itself, some CAS applications (CASPA, for instance) and non-CAS applications also require recommenders to complete an applicant evaluation form (some completed online, some that must be printed), in which the recommender ranks certain characteristics as reflected in the applicant; for instance, maturity, motivation, organization, communication skills, and so on. If required for your applications, you might inform recommenders of this extra step when you send them directions for submitting your letters - see details above, and review the How To Ask section.

Keep a recommendation log

  • We recommend that you track your progress in a log or file. List the people who are writing your letters of recommendation, along with their contact information. Also note what information and materials you have provided each of them, when you gave it to them, and the soft deadline you gave them. Keep all related emails and other correspondence organized in a file so that you can refer back to it yourself, and in case a recommender asks you to re-send something to them.

Confirm that letters have been received

  • In due time, check your CAS application, and contact each non-CAS program, to make sure they have received all of your recommendations, and to confirm that all parts of your application are correct and complete. Submit your application(s) several weeks early. Do not hesitate to call CAS or non-CAS programs directly if you need clarification of recommendation procedures or have other questions about the application. You can also email your questions, but phone calls often yield more useful, direct results. Be sure to log or otherwise track all such communications. Be mindful that programs are especially busy during the application cycle. Be patient, and be persistent only in the most professional and polite manner.

Normally, you will not read recommendation letters

  • Note that the default expectation is that you will not be reading your letters of recommendation - that they will be gathered and submitted in such a manner that you will not have access to their contents. This is the more common expectation of both recommenders as well as professional programs, the idea being that this procedure maintains the integrity of the recommendation process.
  • On rare occasions there might be a reason to not waive your right to read letters. If you have any such concerns you are welcome to discuss them with a HPPLC advisor.

Tips specific to CAS programs

Thoroughly read the above section, General Tips And Suggestions For Both CAS And Non-CAS Programs.

  • Combine the General Tips with the specific tips below. One of the most common mistakes applicants make is paying too little attention to resources within the CAS website itself. Thoroughly read and frequently consult application directions and FAQs.

Entering recommender information into the CAS application

  • With most central application services, the application includes a section where you enter each recommender's name and email address. The CAS subsequently emails a link to the letter portion of your application to each recommender. Note that some central application services  - CASPA, for instance - notify recommenders immediately after you enter recommender information, and don't wait until you actually submit the completed application. Confirm this timing with the CAS for your area, and notify your recommenders ahead of time about what they should expect, and when.

One letter from each recommender

  • For the purposes of the CAS application, each recommender will write and submit only one letter; in other words, the same letter goes to all of your CAS programs.

CAS applicant evaluation forms

  • Some central application services require that recommenders complete an applicant evaluation form, as noted above. If this is the case with your CAS, then when the CAS emails your recommender directions for uploading your letter, they will also inform them about the evaluation form, and how to access it online.

Limits on the number of letters submitted through CAS

  • In the Who To Ask section, we explained that different programs require or prefer different kinds of recommendation letters. It is also the case that some central application services limit the number of letters you can submit. Thus, once in a while an applicant will find that the kinds of letters they need for all of the programs to which they plan to apply exceeds the maximum number accepted through the CAS.
    • If you find yourself in this situation, one approach is to determine which specific letters will cover the most CAS programs, and ask those recommenders to submit through the CAS.
    • For any remaining letters that will not be submitted through the CAS, you would then check the website of the program(s) that requires the given letter to learn how they'd like it submitted (e.g., hardcopy, email, or another way). If their site doesn't provide answers, contact them directly. Be sure to learn whether you will need to provide the given recommender with a blank CAS applicant evaluation form (see above) for them to complete and include with the letter itself.

Tips specific to non-CAS programs

Thoroughly read the section, General tips and suggestions for both CAS and non-CAS programs.

  • Combine the General Tips with the specific tips below.

Different programs, different applications

  • Some non-CAS programs require that you print an application and send in a completed hardcopy, along with hardcopy letters of recommendation. Other non-CAS programs have their own online application, through which letters will be submitted by your recommenders. Thoroughly read application FAQs and directions to learn about each program's requirements and preferences with regard to what kinds of letters you should gather and how they should be submitted. One of the most common mistakes applicants make is paying too little attention to resources within the applications themselves.

Recommenders should not write letters tailored to each program

  • As explained earlier on this page, you should not ask recommenders to write a different version of their letter for each program to which you plan to apply. However, they may need to complete different applicant evaluation forms for different programs - see below.

Non-CAS applicant evaluation forms

  • If your recommenders must complete different applicant evaluation forms specific to given programs, supply recommenders with clear directions for how to access and complete all recommender forms, whether hardcopy or electronic (online or via email). If the application is not online and will be submitted as a hardcopy, along with hardcopy recommendations and evaluation forms, then print copies of any required applicant evaluation forms, give a copy to each recommender, and in the same email in which you've included all other directions, provide them with clearly labeled links to each form for each program, in case they need to print another copy. Your recommenders should not have to hunt around for anything!

If hardcopies are required, provide recommenders with labeled envelopes

(You can skip to the next section if none of your programs require hardcopy submission of letters or applicant evaluation forms.)

  • If some of your non-CAS programs require submission of hardcopy recommendations and/or applicant evaluation forms, then provide each recommender with envelopes. Pre-label each envelope (preferably from a computer printer) with your name and the name of the given recommender ("Letter of recommendation for _______, by _______"). If the given program requires that your recommender completes an applicant evaluation form, then you should put the name of the school and program on the envelope as well (either above or below your name and your recommender's name is fine).
  • In your directions to your recommenders, ask them to sign their name across the flap of each sealed envelope. Doing so is standard practice, and helps maintain the integrity of the recommendation process.  
  • For programs that require hardcopies, usually the applicant gathers the sealed recommendation envelopes, puts them in a larger envelope addressed to the given program, and sends them to the program, along with the completed hardcopy application, if required. (Affix enough postage!)
    • It would be rare for a program to require recommenders themselves to submit hardcopy recommendation letters directly to the program. If such is the case, however, you should also address and pre-stamp the given envelope for the recommender (affix enough postage!). You could use your own address for the return address so that you will know if the letter is returned. Put the For/By information on the back of the stamped envelope ("Letter of recommendation for _______, by _______"). As usual, ask the recommender to sign across the sealed flap.


If You Have Already Gathered Recommendations For A Different Field

It is not uncommon for someone to switch their field of interest; for instance, after additional clinical observation and other career research, a premed student might switch to pre-PA, or a pre-PT student might switch to pre-OT.

If you find yourself in this situation, and have already gathered letters of recommendation that are geared toward your previous field of interest, you may need to ask your recommenders to revise letters according to your new field. Sometimes, for instance, recommendations for medical school admissions will specifically mention "medical school." Do not simply submit the old letters to your new programs of interest! Instead, ask your recommenders if they could revise their letters. They are usually willing to do so, provided you give them adequate notice.

Most recommenders save copies of letters they write on their computer. If a recommender no longer has a copy of the letter they wrote for you then give them your copy or direct them to Interfolio if you have used that service. If you have letters on file with the now-discontinued HPPLC recommendation service HPPLC can still provide recommenders with a copy at the recommender's request.


Final Suggestions

We encourage you to schedule an appointment with a HPPLC advisor. Simply click the Make An Appointment link on our homepage and follow the instructions, being sure to provide all infirmation requested.

If you have not already done so we urge you to sign up for the HPPLC email list associated with your program(s) of interest. You may join more than one list if you wish.




This information was prepared for Indiana University Bloomington students by the Health Professions and Prelaw Center. Please note that specific requirements and policies can change at any time without notice. Students are responsible for obtaining the most current information directly from the application services, and the schools and programs in which they have an interest. Refer to each program's web pages, bulletins, and other publications for the most current information.