Name of Student
UNH Upward Bound
Parent/Guardian Questionnaire
This page should be completed by the parent(s) or guardian(s). Please circle a response for each question that
corresponds to your feelings/opinion. Your answers will be used to determine your child’s acceptance into the Upward
Bound Program. SA= Strongly Agree, A= Agree, N= Neutral, D= Disagree, SD= Strongly Disagree.
My child likes school.
SA
A
N
D
SD
My child has academic difficulty in a certain area. (Please specify.)
SA
A
N
D
SD
My child could do better in school by studying more and/or turning in
assignments on time.
SA
A
N
D
SD
I expect my child to graduate from high school.
SA
A
N
D
SD
I will encourage and help my child enroll in and continue on to college.
I understand that my child is expected to enroll in either a two or four-year
program immediately following high school graduation and is expected earn
either a two or a four-year degree within six-years of high school graduation.
SA
SA
A
A
N
N
D
D
SD
SD
I am excited about my child’s potential participation in the Upward Bound
Program.
SA
A
N
D
SD
I will insist on my child’s regular attendance to school and all Upward Bound
activities.
SA
A
N
D
SD
I will provide transportation to Upward Bound activities as necessary.
SA
A
N
D
SD
In the space provided, please share with us your child’s greatest talents and strengths.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Please share with us whatever challenges you think might interfere with your child going on to and succeeding in college.
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Additional Comments:
Parent/Guardian Name _____________________________________
(Please Print)
Parent/Guardian Signature _____________________________________________
Date _______________