Personal Reference Form

For the Student and Parent

Fill out the form below.



    The Personal Reference Form is for admission purposes. As currently interpreted by the Department of Education, the Act provides that applicants who subsequently enroll will have a right to inspect and review the evaluation if it is retained by the Academy, unless that right is waived in writing. Sign your name below only if you wish to waive your right of access.

    I request that the Personal Reference Form be sent to St. Johnsbury Academy with the understanding that it will be used for admission purposes.

    I understand that I may not read this reference and agree to waive my right of access.
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

For the Teacher

Fill out the form below.


    Your name has been given as a reference by an applicant. The information you provided will be used in the pre-admission process and will not become part of the permanent file. Your assistance is appreciated.
  • Please make the following ratings as realistic as possible, keeping in mind that St. Johnsbury Academy offers a comprehensive curriculum providing remedial through Advanced Placement courses in all academic departments.

    Outstanding vocational preparation is also available.
  • Has the candidate ever been found responsible for any disciplinary violation at your educational institution, whether related to academic misconduct or behavioral misconduct, that resulted in his/her probation, suspension, removal, dismissal, or expulsion from your institution?
  • Please write a summary statement assessing, in as tangible terms as possible, the candidate’s potential for success in a comprehensive boarding school. We are particularly interested in evidence about character, relative maturity, and potential for academic achievement. Refer to both strong and weak points. If the candidate’s record is not a true index of his/her ability, please explain factors that have affected his/her academic achievements.