Please note that I cannot honor requests submitted after June 30.

Name:
Email:
12th Grade Homeroom Teacher:  
Home Phone:
Course(s) Taken with Me:

1.	What is your current career goal and/or what do you intend to major in?  Why did you choose this?
2.	What part of my course were you most successful with?  Try to explain why.
3.	What about my course did you enjoy the most?  Try to explain why.
4.	What part, if any, about my course did you find the most challenging?  What did you do to deal with that challenge?
5.	Did my course ever have you think about something in “real life” that you never thought about before?  If so, please give me an example.
6.	What are some of your extracurricular activities?  Include any paid or volunteer jobs, hobbies, and ethnic affiliations, in addition to sports and clubs, especially if they relate to your career goals.  If these are already listed on the form you fill-out through guidance, you may simply attach that sheet instead.
7.	Is there anything special that you would like me to include in your letter?  Some connection between Chemistry or Science in general and your career goals?  Something personal about you that I might forget -- or might not know about?  Anything at all that you'd like the admissions committees to know but may not show up anywhere else on your applications?  If not, just type "No."
8.  Do you expect to be applying anywhere as an "early admission" candidate?  If you are, where?  Also, it is imperative that you pay attention to your deadline and double check with me at least one week before your letter needs to be in the Guidance Office.
9.  To the best of your ability, list the schools that you think you will be applying to.  If you are submitting this form to me early, I understand that you may not be sure, but give me the most complete list you can.  You can always send me an update via e-mail at a later date.

E-mail your answers to me at adziekanowski@montville.net, or give them to me at school.

Please note that I cannot honor requests submitted after June 30.