Education Service Center Region 12-Connally-UB-Teacher Recommendation

Upward Bound Teacher/Counselor

Recommendation Form
To be completed by School Counselor, Teacher, or Administrator

The following student has applied to participate in the Education Service Center Region 12 Upward Bound Program, a college preparation program. Upward Bound is designed as a year-round, college access program for high school students who demonstrate the interest and ability to go on to post-secondary education. The goal of the program is to develop the skills and motivation necessary to succeed in college. Your assessment of this student's need for academic support and potential for postsecondary enrollment would be greatly appreciated.
Student Name*

First NameLast Name
School
Person Completing this Form
Name

First NameLast Name
Title
Email*
example@example.com
How long have you known this student?
1. Identify Student's Needs: (Check all areas in which student may need help.)

Written Expression/Writing SkillsOral Expression/Speaking SkillsNote Taking SkillsCareer PlanningCollege InformationTutoringSAT/ACT PreparationCommunication SkillsSocial SkillsOrganizational SkillsTSI PreparationInformation on Finacial AidInformation on ScholarshipProfessional EtiquetteTest-Taking SkillsTime Management Skills

2. Compare Student's Performance to their peers.

	Above	Average	Below	Unknown
Overall academic performance
Overall academic potential
Demonstrated leadership skills
Demonstrated respect to others
Social skills/Peer relations
Motivation for academic success
Potential for success in Upward Bound

2. Other comments or information that will assist us in assessing the needs and potential of this student.
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
Send your information to:

Delilah Fernandez, Upward Bound Site Coordinator

(254) 230-5118

FAX: (254) 666- 0823

dfernandez@esc12.net

Upward Bound Teacher/Counselor