Letter Of Recommendation Request Form

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Riverton High School
Letter of Recommendation Request Form
***********************************************
NOTE: Requests for letters of recommendation require one week’s advance notice.
Student’s Full Name:___________________________________
: _________________________
Recommendation requested from
(Circle) Teacher
Counselor
Employer
Administrator
Other
Date Requested: ______________ Date Needed: _______________
Check whichever request applies:
Recommendation letter to be mailed to the following address: (provide
complete name and address AND a stamped envelope)
__________________________________________________
__________________________________________________
City _______________State _______Zip_________________
Recommendation letter to be returned to student in a sealed envelope.
Please provide the following information and complete the student information
requested on the back of this form.
Future/career goals:________________________________________
Post-secondary plans--be specific:______________________________
_________________________________________________________
_________________________________________________________
What accomplishment(s) are you most proud of in the following areas?
*academics? ______________________________________________
*personal?________________________________________________
*school/community service?__________________________________
List 5 adjectives that you feel best describe you as a person:
_________________________________________________________
Have there been (or are there now) any circumstances or adversity that you
believe have had an impact on your academic performance?
Y N
If yes, please explain:_________________________________________
___________________________________________________________
___________________________________________________________.

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