John A. Ferguson Senior High School 

Student Services Department 
Questionnaire for Letter of Recommendation 

Student name: 	ID#: 
Instructions: In order for your counselor to write a meaningful letter of recommendation, please submit your request with this completed questionnaire at least two weeks prior to your desired date of pick up. Be as accurate and concise as possible in your answers. 
Thank you. 
I. 	Goals: What are your career and personal goals? 
II. 	Activities: List any and all activities you have participated in (include school clubs, sports, community activities). Please make special note of any club offices you have held (club president, treasurer, secretary, etc.). 
III. 	Extracurricular Experiences: Describe any summer or foreign programs of study you have participated in (include traveling experiences as well). Explain why you chose to participate in these programs and how you benefited from them. 
	IV. 	Special Awards and Recognition: List any award, honors, or recognition you have received either for academic success, personal success, or community service. Please describe the criteria for having been selected for the award. 

	
	V. Work Experience: List and describe any job you have held, for how long, and when you work. 

VI. On your time off/Leisure Time Activities: Include hobbies, special interests, or talents that you spend time on. Why do you enjoy these? 

VII. 	Challenges, obstacles, or hardships you have had to overcome: Please describe any situation that has changed or impacted your life (example, adjustment to a new environment or country, any physical, emotional, or family circumstances that have presented a challenge, etc.). 
VIII. 	Describe yourself: List what you consider your strengths and weaknesses. List your qualities as an individual that characterize the person you are (include what makes you stand out). 
	IX. 	Colleges/Universities: List the colleges and/or universities you are planning to apply to. Are there any you would like to address specifically? If so, please provide the appropriate form from that institution. 

	
	
	X. Please use this area to make any additional statements that you feel are useful for your counselor in preparing a letter of recommendation for you. 

Date of receipt by counselor: 							Counselor's name: 

Date needed by student: 						Student Signature: