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Burrell College of Osteopathic Medicine Forms

Request for Chair’s Letter of Recommendation for Residency Applicants

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STOP! Please read the instructions in order for your request to be fulfilled.
STOP! Please read the instructions in order for your request to be fulfilled.
-Students should give ample time for the faculty to complete the letter.

-Make sure to first create the letter of entry in ERAS; you will need the letter ID# in order to be able to submit the form

-You will need to have your CV and personal statement ready to be uploaded along with the form. You will not be able to submit the form without those two documents.

-Please make sure to pick the correct specialty you are requesting the letter for

-Contact the clinical faculty assigned to the chair letter via email after submitting this form; they will require a meeting with you

-Filling out the incorrect information will delay your request for a chair letter, and you will be asked to resubmit the form

-Deadline for the student to request a chair letter will be September 1, 2024, 5:00PM MST

Please enter your initials to show you have read/acknowledge the above instructions.

Student Name:*
First Last
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Date Submitted:*
MM slash DD slash YYYY
Student Email:*
Enter Email Confirm Email
Secondary Email:
Enter Email Confirm Email
Student Phone Number:*
Regional Academic Center (RAC):*
You must pick the correct specialty for the chair letter recommendation.
Specialty Area for Letter:*
Please specify the other option:*
Second Specialty (if present):
Please specify the other option:*
Which programs, that you are applying to, require a chair letter?*
Program Link

Please attach the link(s) to the pages of the programs that require a letter next to the program names
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Is this a letter for Internship/Residency application?*
- Yes
- No
AAMC ID (Through ERAS):*
ERAS Letter of Recommendation (LOR) Request PDF:*
Drop files here or

Max. file size: 8 MB.
Tell the Chair About Yourself:
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List 4-6 bulletized comments about yourself that can be included in the letter:*
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Note something about your personality that cannot be gleaned from your application:*
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Comment on how patients perceive you:
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One or two comments on weakness:
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Comment on two cool things about yourself outside of medicine:
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Academic accomplishments you would like emphasized:
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Quartile of Class:
ERAS Letter ID:*
(10 letter and number code) This can be found in your letter entry request. This number is not your AAMC ID number.

This should correspond to what you have chosen as the first specialty above.
Second ERAS Letter ID:
(10 letter and number code) This can be found in your letter entry request. This number is not your AAMC ID number.

This should correspond to what you have chosen as the second specialty above.
Board Scores:
COMLEX Level 1:*
- Pass
- Fail
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COMLEX Level 1 Score:*
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COMLEX Level 1 Score:*
COMLEX Level 2 CE Score:
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COMLEX Level 2 PE:
- Pass
- Fail
Did you take the USMLE Step I?:*
- Yes
- No
USMLE Step I:*
- Pass
- Fail
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USMLE Step I:*
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USMLE Step I:*
USMLE Step II CK:
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USMLE Step II CS:
- Pass
- Fail
Academic performance – Answer only if you desire:
Any class failures or remediation on the transcript?
Any issues to note about performance or professionalism?
Curriculum vitae:*
Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 8 MB.
Personal Statement:*
Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 8 MB.

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