Applying · Guide

PA school letters of recommendation

By The Prereq Club, a pre-PA student and her mom (not PAs or admissions advisers). Every program rule below names its source and the month we checked it: October 2026.

Short answer

CASPA requires you to request at least two evaluations and accepts up to five. Every program we checked wants at least three completed letters by its deadline, and many say who has to write them. Two lets you submit; it isn't enough at any of the programs we checked. UNC Chapel Hill and Augusta require one from a PA. Northwestern requires one from a health care professional, and Touro California requires one from a licensed PA, MD, DO or NP. Several programs don't accept letters from friends or family.

How letters work in CASPA

CASPA calls letters evaluations. Your writers submit them directly, through CASPA's recommender portal.
You must request at least 2 to submit your application, and you can request up to 5. CASPA says to send any extras directly to programs, but some programs, like OHSU and the University of Maryland, Baltimore, only accept letters through CASPA, so ask before sending anything directly.
Many programs have strict rules about who writes, and CASPA warns that completed evaluations "cannot be removed or replaced."
For each request you set a letter due date, which CASPA says should be before your programs' deadlines, can add a personal message, and choose whether to waive your right to see the letter. CASPA says the waiver choice is binding and can't be changed later, and that programs may see a letter you didn't waive as less accurate.
CASPA says it's your responsibility to make sure requests are received and completed on time.

What seven programs require

Program	How many	Who has to write them
UNC Chapel Hill Jan 2027 entry cycle	3	At least two from experienced health care professionals who observed or supervised you in a clinical setting, and at least one from a practicing PA. No personal recommendations. Writers who've known you at least a year strongly recommended
Augusta page checked Oct 2026	3	At least one from a certified PA
Northwestern 2026–27	3 or more (up to 5)	At least one from a health care professional who can discuss how you provide patient care, preferably a clinical supervisor. Friends and family not accepted. No advantage to sending 3, 4 or 5
Touro California (PA/MPH) page checked Oct 2026	3	One from a licensed provider (PA, MD, DO or NP) and one from a supervisor or manager. One person can cover both if your supervisor is a licensed provider; you still need 3 letters in total. Not from friends, family, your own health care provider, or your patients or clients
Pittsburgh page checked Oct 2026	3	Three professional letters: a supervisor from a patient care role, a character reference and a prior instructor (someone who taught or formally trained you). No friends or family
OHSU page checked Oct 2026	3; "will review up to five"	No required sources, but prefers a PA or physician (MD or DO), a current or former work supervisor, and an academic source
University of Maryland, Baltimore 2026–27	3	From people who can objectively comment on your academic or professional performance, preferably a professor; known you at least 6 months recommended. Letters from personal or family friends are "detrimental"

Examples, not a ranking. College of Saint Mary says that if you send more than three, it will ask you to pick three for review.

Missing letters can sink an application

The University of Maryland, Baltimore says your application is incomplete if CASPA hasn't received all three letters, and Pittsburgh won't consider an application that isn't verified by CASPA, or is missing any required material, at its deadline. Touro California accepts letters sent outside CASPA but says that can delay review.

A shadowing PA isn't always the right writer

James Madison says letters are best from people who watched you work or volunteer in patient care, "not simply someone you shadowed briefly." If a program on your list requires a PA letter, plan early to work or volunteer where a PA can see your patient care, so the PA who writes for you knows more than a shadowing day.

How to line up your letters

List the letter rules for every program on your list, then choose up to five writers whose letters together meet each program's rules. A completed evaluation can't be swapped out later. If the rules conflict, ask the programs which letters they will review, or rethink your list.
Ask early. CASPA recommends choosing evaluators early so they have time to submit.
Skip friends and family, even if they work in health care.
Set each due date before your earliest program deadline, and use the message field to tell each writer when you plan to submit and what you'd like them to speak to.
Check each letter's status in CASPA and follow up if it still says "Requested" or "Accepted."

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Quick answers

How many letters of recommendation do you need for PA school?

CASPA requires you to request at least two to submit and accepts up to five. Every program we checked, including UNC Chapel Hill, Northwestern, OHSU and the University of Maryland, Baltimore, requires at least three.

Do you need a letter from a PA for PA school?

At some programs. UNC Chapel Hill requires one from a practicing PA and Augusta requires one from a certified PA. Others vary: Northwestern requires one from a health care professional, Touro California requires one from a licensed PA, MD, DO or NP, and OHSU only states a preference.

Can you replace a letter after it's submitted in CASPA?

No. CASPA says completed evaluations cannot be removed or replaced, so check each program's rules before you choose your writers.

Sources (all opened October 2026)

CASPA Applicant Help Center: Evaluations: https://help.liaisonedu.com/CASPA_Applicant_Help_Center/Filling_Out_Your_CASPA_Application/CASPA_Supporting_Information/1_Evaluations
CASPA Applicant Guide 2026–27 (PAEA): https://e1.nmcdn.io/assets/paea/wp-content/uploads/2026/04/CASPA-Applicant-Guide-26-27-Final.pdf
UNC Chapel Hill PA Program: Admissions requirements (2026–27): https://www.med.unc.edu/healthsciences/unc-pa/admissions/admissions-requirements
UNC Chapel Hill PA Program: Admissions process: https://www.med.unc.edu/healthsciences/unc-pa/admissions/process/
Augusta University PA Program: Requirements: https://www.augusta.edu/alliedhealth/physician-assistant/requirements.php
Northwestern University PA Program: How to apply: https://www.feinberg.northwestern.edu/sites/pa/admissions/how-to-apply/index.html
Touro University California PA/MPH Program: Admissions: https://tu.edu/programs/mspas-mph/admissions/index.php
University of Pittsburgh PA Studies: Admissions: https://www.shrs.pitt.edu/academics/pas/pas-ms/admissions/
OHSU PA Program: Admissions requirements: https://www.ohsu.edu/school-of-medicine/physician-assistant/requirements
University of Maryland Baltimore PA Program: Admissions handbook 2026–27: https://graduate.umaryland.edu/media/graduate-school/documents/pa-documents/Admissions_Handbook_2026_2027remupdated626.pdf
College of Saint Mary PA Program: https://www.csm.edu/academics/health-human-services/master-science-physician-assistant-studies
James Madison University PA Program: Application process FAQs: https://www.jmu.edu/chbs/healthprof/pa/admission-faq.shtml

Rules can change from one cycle to the next. Before you count on any of this, check each program's own admissions page or email the program. This guide is educational only and isn't admissions advice.