SECTION 4: COUNSELOR RECOMMENDATION FORM
Please note that a student’s application will not be processed until all information is received. If a question does not apply to the student, write N/A (not applicable). Please contact Brenda Gatlin, HUB Academic Dean (313.715.4107) with any questions.
1. Does the student have an IEP and/or BIP? If so, please state his/her restrictions or attach a copy (please indicate if IEP/BIP is attached in the space below). Does the student have any physical limitations? If so, please describe:
2. Has the student had any discipline and/or attendance issues? If so, please explain:
3. Please identify the student’s major needs for academic/social enrichment? (check all that apply)
Reading (Oral Fluency, Comprehension)
Math (Foundation, Computation)
4. Does this student have academic potential for post‐secondary education pursuits?
5. Do you recommend this student to participate in Horizons‐Upward Bound?
6. Statement of support:
7. Please attach a copy of the student's transcripts. Also, please attach I-Ready results.
Most recent standardized test results. (PSAT or SAT)
Most recent standardized I-Ready Math test results.
Most recent standardized I-Ready Reading test results.
Counselor/Designated School Personnel Signature
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Should be Empty: