Letter of Recommendation Request Form
- Please allow 2-4 weeks for your letter to be written.
- Do not ask for a letter of recommendation unless you actually need one. Check with the schools to which you are applying.
- Do not ask multiple teachers for the same letter!
- Once your letter is written, I will let you know through email.
- It is expected that you will use the online versions of the applications for me to submit your letter.

Should you experience any problems using this form or notice any errors, please email me.
Name *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Home Phone Number *
Your answer
Cell Phone Number *
Your answer
Email Address (Please use the address that you check regularly.) *
Your answer
Class Rank (Please list as a fraction.) *
Your answer
G.P.A. (Please list your score as a fraction of the possible score.) *
Your answer
ACT Score *
Your answer
SAT Score *
Your answer
AP Exam Scores *
Your answer
Please list five words that you feel describe you as a student or person. *
Your answer
When I fill out an evaluation, I usually have to fill out a series of questions like the ones below. Please rate yourself in the following categories. I will make my own assessment of you, but I am curious to see how you would rate yourself. You should compare yourself to other Neuqua Valley students here and you may want to use your class rank as a guide. *
Below Average
Good (Above Average)
Very Good (Well Above Average)
Excellent (Top 10%)
Outstanding (Top 5%)
One of the top few ever (Top 1%)
Academic Achievement
Intellectual Promise
Quality of Writing
Creative, original thought
Productive class discussion
Respect accorded by faculty
Disciplined work habits
Reaction to setbacks
Concern for others
Initiative, independence
For all of the science courses that you have taken or are currently taking, list the course, teacher and the grade you received. For the courses that you are currently taking, list your probable grade. *
Your answer
What colleges are you trying to get into? Why are you applying to these schools? *
Your answer
What is your intended major in college and what are some careers that interest you? *
Your answer
Please list the personal attributes that you would like me to focus on in this letter. *
Your answer
What was the biggest challenge you had in taking physics this year and how did you deal with that challenge? *
Your answer
What qualities or strengths as a person as well as a student do you see yourself as having demonstrated throughout the year in our classroom? *
Your answer
How did this class help you grow as a student? *
Your answer
What was your greatest success in this class, this does not need to be a test score, it can relate to a skill learned or a relationship formed, etc? *
Your answer
Please list any extracurricular activities or sports in which you have participated. Include the years that you participated and highlight any special accomplishments in these activities. *
Your answer
Please list any community service or volunteering in which you have participated. Include how you helped and the length of time that you volunteered. Also, please describe why you volunteered in this capacity and how this experience impacted you. *
Your answer
Please list any work experience that you have had, including your responsibilities, approximate number of hours per week that you work, and length of time that you were employed for each job. You may also want to include the reason that you sought this particular employment. *
Your answer
Tell me a little about your plans, at this point, for college and beyond. *
Your answer
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