Greater Houston Community Partner-UB-Recommendation Form

The following information must be filled out by your English, Math, Social Studies, or Science instructor, counselor or assistant principal.

Name of Applicant*

First NameLast Name

School*

Grade

The student noted above has applied to the ACHIEVE Upward Bound Program. Upward Bound is a federally funded college preparatory program designed to motivate and prepare a select group of high school students for the successful pursuit of a college education. Upward Bound challenges students to develop the skills, study habits, discipline, and attitude necessary to enroll in and graduate from college.

Please assess the student in the areas of overall academic potential and motivation. In making your assessment, compare the student with others of similar levels of experience and education. This program is for students with high academic potential and the motivation to pursue a college education.

1. How long have you known the prospective Upward Bound Student?*

2. Based on your observations, please rate this student’s performance and/or potential*

	5 Excellent	4 Good	3 Average	2 Below Avg	1 Poor	Unable to rate
Overall academic performance
Overall academic potential
Social skills/peer relations
Demonstrated leaderships
School or class attendance
Determination/motivation for academic success
Attitude
Work Ethic
Verbal/Written Communication Skills

3. What specific areas of academic or social need that Upward Bound may be able to address?*

4. What factors or circumstances may keep this student from pursuing a college education?*

5. What are some of this student’s academic or other strengths?*

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

Name of Person Completing Form*

First NameLast Name

Email*

example@example.com

Title

Signature or initials*

Today’s Date*

mm-dd-yyyy

UPWARD BOUND Teacher/Counselor RECOMMENDATION FORM