Letter of Recommendation Request Form

From Scott DeRuiter (with permission from Tim Krieger and Michael Kanda,
from whom I have shamelessly copied)

Student Name _________________________________

Student Phone Number _________________________________
Student Email _________________________________

Directions:
Complete and return the following information by June 2, 2008 with:
• This completed form on top.
• Answers to the questions typed on a separate paper.
• Any supplemental materials that may include (but are not limited to):
1. Your resume.
2. A sample of a personal essay from an English class that describes something
about you.

The following needs to be given to me, at least four weeks before each is due, in the fall:
• The teacher recommendation form for each school (a maximum of 7 schools), with your
personal information filled out.
• A stamped, addressed envelope to the school, paper-clipped to each teacher
recommendation form. Be sure to make the return address as:

Scott DeRuiter
Monta Vista High School
21840 McClellan Road
Cupertino, CA 95014

I prefer self-sealing envelopes, rather than the licking kind, if you have them.

A. Which other teachers are writing a letter of recommendation for you? __________________
____________________________________________________________________________

B. Name the schools to which you will be applying (no more than 7, and I understand that these
may change): ________________________________________________________________
____________________________________________________________________________

C. Please write a letter that includes answers to the questions on the following page: (be sure
to label each answer with the question number, so it is easy for me to find.)
 Question #1 Remind me of the various experiences/classes that I know you from.
Include any grades that you received (and the year for each experience). For
example..."You were my java teacher during my freshman year and I received an ‘A’
during the first semester and a ‘B’ during the second semester. I would always come in
early (the class was 6th period), and sometimes we would talk during lunch. We would
compare notes about your kids and my younger sister.”

Question #2 Go into more specifics about the above experiences. Tell me what you did
well in my class, what assignments you were most proud of, etc. The more specific you
are, the better. I will be able to write a much better letter of recommendation if I can cite
specific experiences. For example, "After we took the AP exam, I got up in front of the
class and did an impersonation of you. The whole class laughed, and they really got into
it when you sat down at my desk and started to do an imitation of me. Later, the class
took a vote and they decided that my impersonation was better. My favorite chapter was
sequences and series, because . . . “ Write down any stories, memories, etc (they don't
have to be purely academic). Remember, though, that the stories should focus on you
(not me or some other student).

Question #3 List your three most distinguishing, most admirable qualities. Explain each
with several sentences. (Think about what aspects of yourself you would like to have
stressed to colleges.)

Question #4 What type of student are you? What academic settings, subject area(s), or
assignments make you thrive? Which academic subject interests you the most?

Question #5 What are some of your future goals? Why have you chosen these goals,
and why do you think you are equipped to accomplish them? Do you have a path in mind
to achieve these goals?

Question #6 Are you passionate about any activities, person(s), or academic subject(s)?
It could be something you do outside of school, a club you are involved in, or a class at
school (don’t tell me it’s my class, because that’s something I assume anyway ☺).

Question #7 Is there anything unusual about your family (cultural background, shared
interests and activities, travel, size, crises, etc.) that has had a significant impact on you?
How has this affected you?

Good luck and let me know where you end up going! If you enjoyed my class, remember to
invite me to your graduation (whether or not I wrote a letter for your chosen school)!