ACADEMIC VERIFICATION

Upward Bound Frostburg State University 101 Braddock Road Frostburg, MD 21532-1099 (301) 687-4994
ACADEMIC VERIFICATION
To be completed by school counselor:

When evaluating the student please keep in mind:

*A student MUST have the potential to succeed in post-secondary education.

*A student MUST demonstrate academic need.
Student's First and Last Name
School student currently attends
Student's current grade (9, 10, 11, 12)
Grade
School Rank (if known "# out of #")
Curriculum:

GeneralCollege BoundHonorsOther
Is student performing at his/her expected ability level?

YesNo
If NO, please give some indication/example of how student is not working to ability:
Is it realistic for this student to be planning to attend college? (given the student's ability, grades, test scores, and motivation)

YesNo
If NO, please elaborate:
3) Do you have any pertinent comments to make regarding this student's academic abilities and achievement that may have bearing on his/her acceptance into the Upward Bound Program?
NEEDS ASSESSMENT
NEEDS ASSESSMENT: Please check areas in which you feel the student could benefit from Upward Bound services. Check ALL that apply.

Time ManagementNote TakingTest Prep/Test TakingWriting SkillsClass ParticipationListening SkillsAttendanceAttitudeOrganization
COMMENTS (NEEDS ASSESSMENT)
ACADEMIC AREAS
Please check the academic areas in which you feel the students could benefit from Upward Bound services.

ReadingWritingMathematicsSocial StudiesScienceEnglish
Comments (ACADEMIC AREAS)
Did the student test at a proficient level on the READING/LANG ARTS state assessment tests?

YesNoTest Not Taken
Did the student test at a proficient level on the MATH state assessment tests?

YesNoTest Not Taken
Does the student have an IEP or 504 plan?

YesNo
PERSONAL SUPPORT SERVICES

Assistance with SAT or ACT preparationAssistance with college selectionAssistance with career developmentAssistance with high school course selectionAssistance with self-development (motivations, self-esteem, communication skills, social skills)
**Please attach a copy of the student's complete transcript and current grades*

Please return to: esteele@frostburg.edu OR mail to Upward Bound, Frostburg State University, 101 Braddock Road, Frostburg, MD 21532
Signature
Date

MonthDayYear
Date
School
Should be Empty:

ACADEMIC VERIFICATION

NEEDS ASSESSMENT

ACADEMIC AREAS