Academic Verification Form

Upward Bound Math Science

Regional Math/Science Center at Frostburg State University
Academic Verification Form

To be completed by School Counselor
Student Name
Student's 8th grade math class:

Pre-Algebra/8th Grade Math Algebra 1 Geometry Other
What math class will this student take next year?
Which best describe the type of math courses this student is taking?

Honors Merit General
Has this student taken the Algebra I PARCC?

Passed Not Passed Not Taken
Will the student take the Algebra I PARCC this year?

Yes No
Given this student's grades and motivation please rate his/her/their potential for success in a college mathematics or science program

Definite potential for success Potential and motivation are there but student will need a lot of guidance and support Student has the potential but lacks the motivation At this point in time it is not realistic for this student to consider pursuing a degree in mathematics or science Other
Students selected for the Regional Math/Science Center must demonstrate a need for the services we provide. How would you categorize this student's need? Please check all that apply.

Need to improve GPA Predominately low-income community Need to increase confidence or self-esteem Rural Isolation Need to develop stronger educational aspirations Interest in careers in Math and/or Science Need for additional opportunities, support and/or Limited proficiency in English Need to develop career goals Need to improve achievement test scores
Additional comments that might assist us in evaluating this student's application
Please upload or send us a copy of the student's MOST RECENT GRADES and a TRANSCRIPT - including STANDARDIZED TEST SCORES for high school assessments.

Cancel of
Guidance Counselor's Name
School Name
School Phone
Email
example@example.com
School Counselor Signature

Clear
Date

Month Day Year
Date
Should be Empty:

Upward Bound Math Science

Academic Verification Form