| Student’s full name: |
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| Student’s email address: |
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| Current GPA: |
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| List the name of the course(s) you took with this teacher, including the grade you were in: |
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| The reason why you have chosen this teacher to write a rec letter: |
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| Your desired major: |
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| Top 3 schools that you plan to apply to: |
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| School clubs participation: |
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| Extracurricular activities: |
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| Honors and awards you have received: |
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| List 3 adjectives you would use to describe yourself: |
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| What are your unique skills and talents: |
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| Special circumstances (if any): |
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| What else would you like to share: |
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