Fort Valley State University-UB-Counselor Recommendation Form

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Upward Bound Application

SCHOOL COUNSELOR RECOMMENDATION FORM

This student is applying for admission into the Fort Valley State University Upward Bound Program. Upward Bound is a federally funded TRIO program that provides supplemental college preparation assistance, tutoring, and guidance to potential first-generation college students who meet specific federal guidelines. Regulations that govern the Upward Bound Program require documentation of the student’s eligibility, therefore, we are requesting that the School Counselor or authorized custodian of student records complete this form and submit copies of the document(s) listed below. Your recommendation is critical in helping us identify those students with a need for our services and have potential for success in college.

Student's Name*

FirstMILast

Student's Current Grade Level

Current GPA

Student's Current Academic Program of Study

College PreparatoryVocationalTech PrepOther

TO BE COMPLETED BY EVALUATOR:

Name*

FirstMILast

Email*

example@example.com

Phone

(999)999-9999

School

How long have you known the student?

Does the student have an Individualize Learning Plan( IEP)?

YesNo

Please explain

Please rank the student in the categories listed below by using the following ranks:

	Excellent	Good	Average	Poor	No basis to judge
Written Communication Skills
Verbal Communication Skills
Analytical Skills
Leadership Skills
Potential College Aptitude
Organizational Ability
Ability to Work with others
Self-Discipline/Behavior
Respect for Self
Maturity
Judgement
Integrity

PLEASE PROVIDE THE STUDENT WITH:

Most Recent Transcript

Browse Files

Achievement Test Scores

Browse Files

Do you recommend the student for the Upward Bound Program?

YesNoWith Reservations

Signature

Date Signed

mm-dd-yyyy

Comments:

Please verify that you are human*