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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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