Parent/Guardian Input

Question Title

* 1. Student Name

Question Title

* 2. Parent/Guardian Name

Question Title

* 3. Relationship to Student

Question Title

* 4. Parent/Guardian Phone Number

Question Title

* 5. Parent/Guardian E-Mail

Question Title

* 6. High School

Question Title

* 7. Student Grade Level

Question Title

* 8. Does your student need any special accommodations?

Yes (Please Specify)

Question Title

* 9. Do you believe your student is doing the best he/she can do in school?

Question Title

* 10. What are his/her strengths?

Question Title

* 11. What are his/her weaknesses?

Question Title

* 12. What are you doing at home to assist your student in doing better in school?

Question Title

* 13. What services could benefit your student?

Exposure to different colleges

Stress/time management

PSAT/SAT/ACT Prep

Financial Aid Information

Regents Prep

Choosing a college major

Cultural acitivities

Tutoring

Parent/Guardian Input

Question Title

* 1. Student Name

Question Title

* 2. Parent/Guardian Name

Question Title

* 3. Relationship to Student

Question Title

* 4. Parent/Guardian Phone Number

Question Title

* 5. Parent/Guardian E-Mail

Question Title

* 6. High School

Question Title

* 7. Student Grade Level

Question Title

* 8. Does your student need any special accommodations?

Question Title

* 9. Do you believe your student is doing the best he/she can do in school?

Question Title

* 10. What are his/her strengths?

Question Title

* 11. What are his/her weaknesses?

Question Title

* 12. What are you doing at home to assist your student in doing better in school?

Question Title

* 13. What services could benefit your student?

Question Title

* 14. What do you hope your student gains from participating in the Upward Bound program?

Question Title

* 15. Please explain any other academic/educational or social concerns that you have.