So you’ve decided you want to become a physician assistant, and soon you’ll be sending out PA training program applications. Letters of recommendation can be a pivotal part of the process, so you have some things to keep in mind to maximize your chance of acceptance. The following checklist should help avoid critical mistakes.

1. Start tracking your letters down early. You should start asking references if they are willing to write you a letter early because it takes time to secure an agreement from writers, it takes time for your references to actually write their letters and submit them, and generally speaking, the earlier your application is complete, the better your chances of getting in. This is particularly true if you apply through CASPA.

2. Use references that will have broad appeal. Most schools will have you apply via the Central Application Service for Physician Assistants (CASPA). CASPA requires you to obtain three letters of reference. Once received, CASPA will distribute the same three letters to each school to which you are applying. For this reason, you should choose references that will have appeal to the widest range of schools. If you are concerned about appealing to the specific requirements of a particular school, you can speak to these in your essay, or in a secondary application, which you may complete later in the application process.

3. Clinical references are usually better than academic references. In most cases, schools prefer to learn about your clinical experiences than you academic performance. This means seeking out references who have supervised you or worked closely with you in a clinical (patient) setting. It makes sense, because this information speaks directly about your potential as a PA. The only exception is if you have a weak academic background (low grades or your coursework is more than 3 years old). In this case, you should consider getting one letter from the instructor of a class that you did well in, preferably in a science prerequisite.

4. Seek out letters from people you are sure support you. It may sound obvious, but many people don’t. Find someone who truly likes you, and who supports your decision to apply for PA training. If you are unsure, ask them: “I am going to be applying to physician assistant schools, and I’m beginning to think about my letters of reference. Would you feel able to support me by writing a letter of reference if I asked you to?” If their response is anything less than an enthusiastic “Yes!” then consider finding someone else.

5. Use the electronic submission method if at all possible. Electronic submissions are easier on you, your reference, CASPA, and the schools you hope to attend. Simply provide CASPA with the name, title, degree, and email address of your reference, and how he or she knows you. Let your references know in advance when you will be submitting their information so they can gauge when the letter will need to be written. Once they have completed their letter they will email it to CASPA. Exception: if you are submitting a letter from an admissions committee. Letters from committees count as a single letter and must submitted as hard copies, on institution letterhead.

6. Waive your right to review your letters. CASPA gives you the option to waive your right to review your letters, and you should. Not waiving this right signifies that you may wish to view them yourself, and implies that you aren’t confident that they speak well of you. This is a little like like asking a potential employer not to contact your previous employer - a definite red flag to an applications committee.

7. When complete, send a thank you card to your letter writers (and maybe even a small gift — Starbucks gift cards are appropriate). This is just good manners. It shows your appreciation and keeps you in their good graces should you need to reapply next year.

Once your letters are completed and submitted, you can cross this item off your extensive to-do list and breathe a little easier. Good luck!