Western Kentucky University-UB-Recommendation Form

This form must be completed by a Guidance Counselor, or a Math, English, Science, Social Studies, or Foreign Language teacher.

Student Name*

First NameLast Name

School

Academic Potential

Does the applicant have a desire and/or determination for academic success?*

YesNo

Does the applicant possess the academic potential to continue his/her education beyond high school?*

YesNo

Academic Background

Is the applicant “on track” to graduate with his/her class?*

YesNo

Does the applicant have attendance problems?*

YesNo

Does the applicant have discipline problems at school?*

YesNo

Please explain any student grade, attendance, or discipline concerns

Academic Need

Please check all of the following which apply to the student:

will need help with taking of College entrance Examswill need help with college financial aidwill need help with college applicationsneeds tutoring/enhancement in at least one of the core subject areasPersonal and/or family difficulties

Please review entire list of (12) options and check up to 2 of the following

Recommendation for participation*

strongly recommendrecommend with reservationdo not recommend

Additional comments on applicant that may aid us in our selection process

Counselor/Teacher Name*

First NameLast Name

Title

Counselor/Teacher Email*

example@example.com

Counselor/Teacher Signature

Date

mm-dd-yyyy

Upward Bound
Western Kentucky University
1906 College Heights Blvd.
Bowling Green, KY 42101-1098
Telephone: (270) 745-4873
Fax: (270) 745-2031
Website: www.wku.edu/upwardbound

Counselor/Teacher Recommendation Form