TEACHER RECOMMENDATION
FORM
UPWARD BOUND PROGRAM
Lock Haven University of
Pennsylvania
Russell Hall 13 2 Lock Haven, PA 17745
Phone: (570) 484-2409
Student's
Name:______________________________
School:______________________________
Teacher's
Name:______________________________
Phone:______________________________
Relationship to Student:
Teacher
(Class)_________________________
Other:_______________________________
High School
Counselor:___________________________________________
From your observations and
interactions with this student, please circle the number
which best describes his or her:
(Please respond to all
questions – make your best guess if you have to.)
| |
Very High |
High |
Avg |
Low |
|
1) Demonstrated interest in math |
4 |
3 |
2 |
1 |
|
2) Demonstrated interest in science
|
4 |
3 |
2 |
1 |
|
3) Level of motivation to succeed academically
|
4 |
3 |
2 |
1 |
|
4) Perseverance in completing tasks |
4 |
3 |
2 |
1 |
|
5) Willingness to follow directions |
4 |
3 |
2 |
1 |
|
6) Demonstration of appropriate classroom
behavior |
4 |
3 |
2 |
1 |
|
7) Number of unexcused class absences
|
4 |
3 |
2 |
1 |
|
8) Overall positive attitude about academics
|
4 |
3 |
2 |
1 |
|
9) Academic potential for post secondary
education |
4 |
3 |
2 |
1 |
|
10) Likelihood of
benefiting academically and personally from
Upward Bound Services |
4 |
3 |
2 |
1 |
|
11) Likelihood of
pursuing post secondary education on
his/her own |
4 |
3 |
2 |
1 |
|
12) Level of opportunity to work with
technology tools |
4 |
3 |
2 |
1 |
|
13) Level of
opportunity to meet/work with professionals,
other than teachers |
4 |
3 |
2 |
1 |
Please help us to better assess this student’s ability to
complete post secondary degree by commenting freely upon his
or her strengths, abilities, special talents, or needs in
the space below.
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
|
