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Reference Letter Request Form:
Student Information Worksheet
Think of teachers who know you well.
Student Information Work-Sheet
Fill out the work-sheet as completely as possible
Not all sections may apply to every student
Fill out one work-sheet per reference letter
requested
Written Statement
Create a written statement describing yourself
by including:
Your academic interests / plans for the
future
Your strengths
Attitude and/or skills which may help you
be academically successful in your post-
high school plans
Attach your written statement to this worksheet
Make an appointment to ask the teacher /
teachers to write a letter of
recommendation for you.
Plan ahead to meet your timeline
Allow each teacher 10-14 days for the
completion of the letter
DO NOT assume the letter will be completed if
you leave the request in the teacher’s mailbox.
Make sure you make a personal contact with the
teachers
During the appointment provide:
A self addressed, stamped envelope
Completed information work-sheet
Thank You Letters:
Write a short “Thank You” letter (note) to the
teachers who have supported you and provided
a reference letter
“Thank You” letters (notes) may be e-mailed to
the teachers utilizing their school e-mail
addresses
Student: When requesting a letter of
recommendation from a
teacher, be aware to:
Student Instructions:
Students Responsibilities:
A completed Student Information Worksheet
(opposite side)
Addressed, stamped envelope
Student Criteria you may wish to consider:
Scholastic ability
Motivation
Reaction to Criticism
Initiative
Emotional Stability
Personality
Integrity
Cooperation
Maturity
Leadership Qualities
Other Considerations, you may wish to
include:
Examples or Anecdotes
Illustrating the student’s character
Illustrating the student’s judgment
Accuracy of “First-Impression”
Do you feel the same?
Why?
Why this particular school is a match for the
student
Other faculty members comments / input
Comparison w/ previous candidates
Personal Information:
Phone Number for further information about
this student
High School contact information
Additional Copies:
Xerox a copy in case another letter is needed for
this student
Please Note: In order to assist you with a
meaningful letter of recommendation, the
student has been asked to fulfill their
responsibilities.
Faculty Instructions:
Suffield High School
1060 Sheldon Street
West Suffield, CT 06093
Phone: 860-668-3810
*Remember to attach your personal statement before giving this form to the person you'll be requesting a letter from!
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Whatever the mind of man can conceive and believe, it can achieve. Thoughts are things! And powerful things at that, when mixed with definiteness of purpose, and burning desire, can be translated into riches. | Napoleon Hill