Upward Bound Mentor Recommendation Student Name: Grade Level By Credit: Mentor/Reference: This student has applied to participate in the Upward Bound Program. The information requested will help us in determining the student’s needs. Please fill in the form adding any appropriate comments as needed. Completed forms can be turned in to the Upward Bound staff or mailbox. Thank you for your assistance. Please give your perception of this student’s academic potential. Include academic, social and family factors: In your opinion, what is this student’s most significant academic need? Attendance: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Academic Ability: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Attitude: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Motivation for Enrolling in College: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Study Skills & Habits: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Ambition: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Participation: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Communication: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Reliability/Commitment: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Behavior/Respect for Authority: Poor (1) Fair (2) Average (3) Good (4) Excellent (5) N/A (0) Please indicate which categories best describe the student’s needs: Lack of opportunity, support, and/or guidance to take challenging college preparation courses Lack of career goals and/or need for accurate information on careers Limited english proficiency Lack of confidence, self-esteem, and/or social skills Predominantly low-income community Rural isolation Interest in careers in math or science Diagnosed learning disability Other (see above) Print Name: Electronic Signature: I Agree Title: Date: Relation to Student: Send
