Name: ID #:

Email:
Request for a Counselor Letter of Recommendation
Checklist
Counselors will not begin to work on your Letter of Recommendation
Request until ALL items listed below are complete and submitted by
the 20 school days required to process and write a letter. Deadline
dates are listed on the following page, and will be strictly enforced. You
can type on this document until Step 5- from there you need to print.
Step 1: List of schools being applied to requiring a letter of
Recommendation
Step 2: Family Background Information
Step 3: Short Essays
Step 4: Formal Teacher Letter of Recommendations (for
institution)
Step 5: Teacher Evaluations Forms (for counselor)
Step 6: Outside Recommendation Form completed and returned
to my counselor
Step 7: Parent Comment Form completed and returned to my
counselor
Step 8: Activities and Awards Resume completed and given to
my counselor

Request for Counselor Letter of Recommendation

Let your counselor know ASAP that you will be asking for a letter of recommendation, and let
them know when you will have all your materials submitted to them using the chart below.
OBSERVE ALL DEADLINES! Counselors need a minimum of four weeks (20 school days) to
review your academic record, short essay responses, teacher evaluations, and write a thoughtful
letter of recommendation. IT IS YOUR RESPONSIBILITY TO GET THINGS IN ON TIME. No
counselor will begin writing for you until all components of this packet are completed! (Note:
holidays, weekends, budget reduction days, and staff development day are not parts of the four
working weeks)
*Double check to make sure your school requires a counselor recommendation, not all
schools will require one.
College
Application
Deadline

Materials to
Counselor

College
Application
Deadline

Materials to
Counselor

November 1
November 15
December 1
December 15
January 1

October 2
October 16
October 27
November 10
November 13

January 15
February 1
February 15
March 1
March 15

December 4
December 17
January 14
February 5
February 19

State schools typically DO NOT require a counselor Letter of Recommendation, while private
universities and colleges do. Private schools also typically ask for one or two teacher
recommendation letters. Give teachers the same time courtesy that counselors require for letter
writing. Be sure to look carefully at each schools website for application requirements (what
teachers they want to write for you, scholarship deadlines, preferred dates, SAT Subject tests
required, etc.).
Step 1: List of Schools. If you are applying to a school requiring a counselor Letter of
Recommendation, please use the on-line Common Application if it is an option. The Common
Application is an admissions application accepted by most private schools that can be used for
multiple college applications. It will save you, your teachers, and your counselor many hours of
time. In addition to the Common Application, many private schools require a supplement
application. Be sure to make a calendar/spreadsheet with ALL deadlines recorded on it to track
your progress.
Please list below the school(s) you are applying to that require a Counselor Letter of
Recommendation
(Note: WHS recommends 2or 3 reach schools, 2-3 competitive schools, and 2-3 safety
schools)
Name of College/University
Application Deadline Common Applications
1

Yes
No
2

Yes
No

3
4
5
6
7
8

Yes
Yes
Yes
Yes
Yes
Yes

No
No
No
No
No
No

Note: By requesting a letter of recommendation from your counselor you are agreeing to our
release of information regarding your academic and personal activities to requested parties.
Academic integrity concerns will also be shared if any arise.

Step 2: Family Background Information.

Parent / Guardian name(s) with whom you are living with:
Did either of your parents attend college?

Yes

If yes, please list colleges: Father / Guardian

Mother / Guardian

No

Fathers Occupation: Employer:

Mothers Occupation: Employer:
Number of children in your family and ages:

How many family members are in college now?

What colleges are they attending?
Military History of Father:

Military history of Mother:

Step 3: Short Essays.
Thoughtfully craft answers to the following questions. Answer each question as if a school
representative was interviewing you. Schools are looking for students who demonstrate strong
character, evidence of leadership, along with other qualities and talents. What do you want a
school to know about you? What differentiates you from other students? Why should a school
feel confident that you would be academically motivated to achieve in college? Be authentic and
honest.
A. List three adjectives that you feel best describe you and explain why:
purposeful, visionary, devoted

B. Describe your most positive personality or behavioral characteristic and how it has shaped
who you are.

My tenacity for seeking opportunities sets me apart from other students at Westview and
has largely dictated my life both inside and outside the school environment. I firmly believe
that learning occurs best through application. In subjects that greatly interest me, such as
computer science and math, I am always looking for opportunities to apply my current skills
and gain new ones. Often times when completing an application, it is easy to not put full
efforts into an essay, or even entirely give up on an application problem, but my
determination carries me through. As a result of this quality, I have obtained distinct
opportunities and experiences that differentiate me from many other students.

C. What academic areas would you like to explore as a college student? What goals have you set
for yourself, and how do you plan to accomplish them? Fully explain your answer.

Throughout my high school career, Ive developed great appreciation for the far reaching
nature of computer science. As a college student, Id like to continue my study of computer
science while simultaneously developing a deeper understanding of the other sciences.
Throughout my time in various research positions and internships Ive noticed a simple truth:
no science truly stands alone. The greatest biologists often need an understanding of
physics, the most successful chemists requiring the power of computer simulation, and so
on. As a result of this inherently interdisciplinary nature of science, my long-term
academic/career goals remain relatively general (thankfully made possible by the flexibility
of the American education system). Through my schooling, I would like to establish a strong
academic and research background while continuing to develop a deep understanding of
societys significant problems which I would like to solve. Having framed such a problem, the
logical next step is to work towards a solution which I could accomplish through multiple
avenues. I could join an enterprise which also is working on said problem, start a venture of
my own, or continue my journey in academia through research and faculty.
D. Over the last four years, what have you done that would make a college feel you would be
motivated to take advantage of the opportunities available at their school? Be specific - tie your
answer to your interests, work habits, and life goals.

The opportunities Ive pursued continually demonstrate an interest in research while

providing a sound scientific background.
Research requires a mindset when analyzing problems and developing solutions. Like many
skills, this mindset takes time and practice to develop, making any professional experience
greatly beneficial to an aspiring researcher. Such experience is what I have gained through
various programs and internships. In 2014, I was accepted to the Partnerships in Scientific
Inquiry program run by faculty members at the Oregon Health and Science University. The
program centered on analyzing and critiquing biomedical research, largely with the goal of
combatting Parkinsons disease. As a member, I participated in various journal clubs,
providing me with invaluable background in comprehending and critiquing biomedical
literature. Additionally, the program paired me with a professor of the Casey Eye Institute at
OHSU, Dr. Gangjun Liu (in the Dr. David Huang Lab) with whom I conducted research. As Dr.
Lius intern, I helped develop an algorithm to measure total retinal blood flow through optical
coherence tomography.
Last year, I began my journey into machine learning. I attended weekly seminars at Portland
State University which discussed machine learning methods in algorithmic trading and
option pricing, under Dr. Marek Perkowski. While much of the research presented had little to
do with biomedicine, my technical abilities in machine learning grew vastly, and I gained

exposure to a plethora of computer science literature. Having understood the pervasiveness

of computer science in biomedicine and early cancer detection, I was motivated to find
research opportunities and in the summer of 2015, I was accepted to a research position in
the molecular imaging department of the Canary Center for Early Cancer Detection at
Stanford. As a culmination to these programs, this past summer, I attended the prestigious
HSHSP research program.
While not explicitly researching, I stay busy working as a software development intern at
Intel. I am presently working on the development and testing of internal business
applications which properly allocate Intels Market Development Fund to Original Equipment
Manufacturers. Perhaps most important, is the experience I have gained working in a
professional business environment one similar to various research settings. In such
environments, your mentor will inevitably be unable to attend to all of your issues/concerns.
While at Intel, Ive learned to be independent and resourceful in the absence of a superior,
however frustrating it may sometimes be.
Although incredibly widespread, these internships, contests, and hobbies are all unified by
my undying interest and demonstrated ability to undertake research.
E. Is there anything you would like sited in your letter as evidence of your leadership ability?

I was a founding member of the Westview History Bowl and Quiz Bowl clubs, leading our
team to state and national recognition. I have served as a state appointed committee chair
of various committees in Oregon Model United Nations. I have also served as team captain
for both our nationally qualified Science Olympiad and Science Bowl teams.
F. Describe how you have demonstrated strong character (e.g. integrity, independence, loyalty,
citizenship, self-discipline, willingness to work hard, kindness, commitment to high ideals, and
care for others)
In the summer of 2015, I was accepted to a research position in the molecular imaging
department of the Canary Center for Early Cancer Detection at Stanford. This was definitely
my most challenging research experience. However, as a result of my undying passion for
the problem at hand, I persevered. The first two weeks were spent reading large amounts of
literature, from sections of image processing books, to previous doctoral theses. From there,
I was handed a general problem whose solution, for the first time, I felt I had complete
control over. Possessing this much responsibility was both a liberating and daunting
sensation. I found myself going to sleep thinking about my code or different ways of
approaching the problem, something I had only previously experienced when engrossed with
a competition math or Olympiad problem. My interest in the research and project made the
results and selection for presentation at the World Molecular Imaging Conference all the
more enjoyable
G. Do you have a special talent or originality in any specific field such as art, music, science,
literature, or mathematics? Please describe your experience/involvement.
At its core much of science depends on problem solving - a skill that has led me to great
success in the STEM field. I owe the foundation of my problem solving to competition math.
However, my freshman year of high school I nearly lost interest in competitive math. In
short, I was dubious about the applications of pure mathematics. That summer, I was given
a full scholarship to the Summer Institute of Mathematics at UW, a life-changing acceptance.
I had heard that the program was more research oriented than other programs which
prepared you for competition math. While there, I realized what Id been missing: the
intrinsic value of math Olympiads is the type of thinking they require. While the answer may
truly be insignificant, my path to the solution is what will help me years down the road. For

similar reasons, I enjoy competing in various Olympiads for coding, math, and physics and
thus do practice problems in my free time. Ive qualified twice for the AIME, placed in the top
15 for ARML, and placed in the Oregon Invitational Mathematics Tournament. Additionally,
last year, I placed in three Science Olympiad events at state, helping our team win the state
competition and advance to the National Science Olympiad. I also captain our Science Bowl
team and will be submitting my research from this summer to our state science fair.
H. Is there anything else that you feel would be important to include in your letter additional
qualities, anecdotes, circumstances, or background information that would give a school insight
as to who you are?

I like to relax by playing basketball and football with friends, lifting, browsing Quora and reading a
good book.

Step 4: Formal Teacher Recommendation Letters (for institution as needed).

What teacher(s) will you be requesting a Formal Letter of Recommendation from?
(Teacher/Subject)
Fabian Mak/AP Physics C,

Lee Buelt /AP Literature,

Step 5: Teacher Evaluation Form

To be used in the Counselor Recommendation Letter
(Student: Make 3-4 copies of this form and give it to current or
former teachers you feel know you best, and can provide valuable
information for your counselor regarding your personal and academic qualities.)
Student Name: ______________________________Completion Deadline: _____________

Teacher Name: ______________________________Class: __________________________

Counselor Name: ___________________________
Thank you for taking the time to complete this form. My counselor is gathering
information that will help her/him write my letter of recommendation. Because she/he
does not have daily contact with me, your evaluation and comments are important. You
provide valuable insight about my academic and personal development and potential.
Please return this form directly to my counselor by the above completion
deadline. All comments are kept confidential and will not be shared with the student.
What three words would you use to describe this student?
1

Example

Example

Example

Describe this students academic abilities and performance in your class. You might
want to comment on the students study habits, dependability, creativity, self-discipline,
commitment to high ideals, caring for others, etc.

Has this student demonstrated evidence of leadership ability in class or in activities

outside of your class that you are aware of?

What differentiates this student from other students?

Are you confident that this student would be academically motivated to achieve in
college? Please explain.

Is there any other information about this student that would be important to mention in a
letter of recommendation? (For example: personal setbacks, extenuating
circumstances, obstacles to overcome, etc.)

Please complete the grid below. Compare this student with other seniors you are
teaching this year. How would your rate them in terms of:

Below
Averag
e

Averag
e

Good/Abov
e Average

Very
Good/We
ll Above
Average

Excelle
nt (Top
10%)

Outstandi
ng (Top
5%)

One of the
top few
encounter
ed

Creative,
Original
Thought
Motivation
SelfConfidence
Independen
ce, Initiative
Intellectual
Ability
Academic
Achievemen
t
Written
Expression
Effective
Class
Discussion
Disciplined
Work Habits
Potential for
Growth

Step 6: Westview High School

Outside Recommendation Form Request
Student Name: __________________________ Completion Deadline: ________________
Outside Source Name: _____________________________________

Counselor Name: _________________________ Counselor email: ________________________

Thank you for taking the time to complete this form. My counselor is gathering
information that will help her/him write my composite letter of recommendation for my
college applications. Your evaluation and comments are very important components to
my letter. Please return this form directly to my counselor by the above
completion deadline. You can return it to me in a sealed envelope, e-mail it to my
school counselor at the above e-mail address, or send it directly to my school counselor
at the address below.
(All comments are kept confidential and will not be shared with the student)
Name of School Counselor: ________________________
Westview High School
4200 NW 185th Avenue
Portland, OR 97229
To the Recommender:
Please complete the following questions about the above student.
In what capacity do you know this student? (For example, soccer coach, employer, youth
pastor, etc.)

Describe the activities or duties where you have observed this student.

Describe the abilities and skills you have seen this student demonstrate.

Comment on this students dependability, citizenship, persistence, initiative, and

maturity.

Comment on this students relationship and other people (communication, skills,

friendliness, etc.)

Describe any leadership skills this student has demonstrated.

Describe any personality characteristics or behaviors this student has demonstrated that
you have appreciated.

Are you confident that this student would be motivated to succeed in college? Please
explain.

Describe anything else about this student you feel a counselor should know to write an
effective and specific recommendation letter.

Step 7: Westview High School

Parent/Guardian Recommendation Form Request
Student Name: _________________________ Completion Deadline: ________________
Parent Name:

__________________________ Counselor Name: ____________________

Counselor email: _________________________________

Thank you for taking the time to complete this form. My counselor is gathering
information that will help her/him write my composite letter of recommendation for my
college applications. Your evaluation and comments are very important components to
my letter. Please return this form directly to my counselor by the above
completion deadline. You can return it to me and Ill deliver to my counselor, e-mail it
to my school counselor at the above e-mail address, or send it directly to my school
counselor at the address below.
Name of School Counselor:
Westview High School
4200 NW 185th Avenue
Portland, OR 97229
What do you like best about your student?

Please give me your frank comments on your students strengths and weaknesses.

Describe your students community and/or school activities, awards, or special

experiences that you think were worthwhile or interesting in some way.

Describe any specific life experiences your student has had that has affected who she/he
is today. (For example, a divorce in the family, a foreign exchange experience they had,
a particular work experience, or a person who enriched the students life, etc.)

Please share anything else you feel the counselor should know to have an accurate
picture of your student.

Students: Below is a sample Activities and Award Form. Please

complete your own (in this format), so that we can provide the
most comprehensive picture of you to your school.
Student's Name:
Category
HONORS
National AP Scholar Award
AP Scholar with Distinction
National Merit Semifinalist

Grade

Hours per Week

12th
12th

Mathematics
Oregon Invitational Mathematics Tournament Top 10
2013, 2014 American Invitational Mathematics Examination (AIME) qualifier
2014 full scholarship to Summer Institute for Mathematics at the University of
Washington
One of 30 selected across the Pacific Northwest
2013 nationally qualified for American Regions Math League
POSITIONS OF LEADERSHIP
Student Council Treasurer
week
JVH Soccer Captain
week
Japanese Club President

11th, 12th

2 hrs per week

SCHOOL ACTIVITIES
Student Council
National Honor Society
Prowl Editor
Japanese Club
Cantores

10th - 12th
11th, 12th
11th, 12th
9th - 12th
11th, 12th

2 hrs per week

1-2 hrs per week
6 hrs per week
1 hr per week
4 hrs per week

SPORTS
Dragon Boat
week
JV Soccer
Swim Team
COMMUNITY ACTIVITIES

11th, 12th

10 hrs per

11th, 12th

10 hrs per

12th
11th, 12th
9th, 10th

6 hrs per
15 hrs per week
12 hrs per week

Outdoor School Counselor

Boy Scouts of America
Church Youth Group

11th, 12th
9th - 12th
9th - 12th

144 hours
2 hrs per week
2 hrs per

week
Oregon Humane Society Volunteer
per week
WORK EXPERIENCE
Cashier (Target Stores)
Lifeguard (YMCA)
week
Baby Sitting

9th, 10th (summers)

6 hrs

12th
20 hrs per week
11th, 12th (summers)
16 hrs per
9th, 10th

OTHER INFORMATION
Cumulative GPA: 3.85
Class Rank: 32 out of 649
Completed CIM Requirements

10 hrs per week