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Parent/Guardian Input
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1.
Student Name
(Required.)
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2.
Parent/Guardian Name
(Required.)
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3.
Relationship to Student
(Required.)
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4.
Parent/Guardian Phone Number
(Required.)
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5.
Parent/Guardian E-Mail
(Required.)
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6.
High School
(Required.)
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7.
Student Grade Level
(Required.)
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8.
Does your student need any special accommodations?
(Required.)
No
Yes (Please Specify)
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9.
Do you believe your student is doing the best he/she can do in school?
(Required.)
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10.
What are his/her strengths?
(Required.)
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11.
What are his/her weaknesses?
(Required.)
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12.
What are you doing at home to assist your student in doing better in school?
(Required.)
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13.
What services could benefit your student?
(Required.)
Exposure to different colleges
Stress/time management
PSAT/SAT/ACT Prep
Financial Aid Information
Regents Prep
Choosing a college major
Cultural acitivities
Tutoring
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14.
What do you hope your student gains from participating in the Upward Bound program?
(Required.)
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15.
Please explain any other academic/educational or social concerns that you have.
(Required.)