Elizabethtown Community & Technical College-UBMS-Recommendation Form

ECTC Upward Bound Math and Science Evaluation/Recommendation Form - Science/Math Teacher or Guidance Counselor
Applicant Name:*

First NameLast Name
Assessor Name:

First NameLast Name
Email:*
example@example.com
Thank you for assisting with the ECTC UBMS program’s efforts to ascertain the above-named applicant’s suitability for participation in our program. Please address the evaluation categories and use the scale provided to rate the applicant. Your insight on this applicant is appreciated.

Categories:

	4 = Exceptional	3 = Good	2 = Fair	1 = Poor	0 = No
Academic Ability/Potential
Responsible Attitude towards school work
Leadership ability
Respect/Concern for others
Motivation for Success
Current level of academic performance

Respond Yes, No, or Unknown:

	Yes	No	Unknown
1. Is there parental involvement?
2. Has demonstrated a basic understanding of grade-level science/math?
3. Involved in disciplinary action?
4. Will the student profit from participation in the UBMS program?
5. Additional academic evaluations suggested?
6. Will the student need additional services to be successful?

DO YOU FEEL THIS STUDENT HAS THE POTENTIAL TO BE SUCCESSFUL IN A TWO OR FOUR-YEAR COLLEGE (EVEN IF NOT PRESENTLY ACHIEVING)?

YESNO
DO YOU RECOMMEND THIS STUDENT FOR THE ECTC UPWARD BOUND MATH & SCIENCE PROGRAM?

YESNO
Comments:

ECTC Upward Bound Math and Science Evaluation/Recommendation Form - Science/Math Teacher or Guidance Counselor