Reference Request Form

1. Please read the notes at the end of this form carefully before completing
2. Check your tutor is still working at the University by searching the staff directory
3. Fill out the information in Section A and sign the information release section
4. Once completed, please send it to the organisation requiring a reference, they should fill
out Section B
5. Once the organisation has completed section B the organisation should email
careersref@mdx.ac.uk the completed form and any other information they need .

Section A – Completed by Alumnus

Please complete the following fields and forward to your employer. All fields are mandatory,
if any are left blank we will not be able to provide you with a reference.

Name

Name while studying (if different from above)

DOB of alumni

Student ID number (usually begins M00)

OR

Course studied and year graduated

Personal email address

Name of up to 3 academics still working at

the University

Information Release:
I give my consent to the organisation named below to verify the information presented above
on this form, and any other information required by the organisation that forms part of their
reference process.

Signed (can be typed):

Date:
Print Name:
Section B – Completed by Requestor

Please complete the fields below and return to careersref@mdx.ac.uk.

When returning please let us know what needs to be included in the reference or attach any
additional paperwork for completion.

Name of organisation/institution requesting

the reference
Position alumnus has applied for/prospective
course of study
Email address and phone number of
reference requestor

Notes to alumnus

 You will not receive a copy of the reference, it will be sent directly to the employer/institution
who you have given permission to request a reference and who has contacted us
 The email address CareersRef@mdx.ac.uk is for third party requests only, personal emails will
not be responded to, and you will be referred to the steps above
 If your tutor is no longer working at the University, we are not able to provide a reference.
Instead you are able to request an Award Letter as a confirmation of your qualification/s
obtained at Middlesex University. If you would like an Award Letter please request one via
UniHelp.
 This process is for cases where you need a more personalised reference only, if you require
basic verification for a Higher Education Institution or an Embassy please submit this via
UniHelp, and select ‘Award Letter’ or ‘Embassy Verification’
 Unless the above steps have been completed, we will not be able to provide a reference;
it is your responsibility to ensure that all information is included on the form and that
the relevant academic is still working at Middlesex