Program Description:
UT SCORE are four week-long summer events for rising high school juniors from Memphis area Schools.
This program is designed to educate students about the college application process, college success, and
introduce them to the skills it takes to be successful in earning a degree. UT SCORE will expose students to
majors in college that will lead to careers that interest them. Four current UT Knoxville students, who are
graduates of Memphis high schools, will serve as SCORE Counselors to the high school participants. They
will instruct students about college preparation along with the application and selection process.
Additionally, they will share strategies to be successful academically and socially in college.
The UT SCORE Program will last one week. Each of the four, one week sessions, includes space for 40
participants in learning teams of 10. The program will take place on the UT Health Science Center campus
in downtown Memphis for four days and on the Southwest Tennessee Community College Union Campus
for one day each week. The participants will also visit other local colleges and universities.
Application Instructions
1. Please verify that you meet all eligibility requirements. Applicants must:
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Be a rising sophomore or junior Be a 1st generation college student (parents did not complete a 4yr college bachelor’s degree program) OR be a participant in the Federal Free/Reduced Lunch program Have a minimum 2.75 (weighted) cumulative grade point average Be available for one week (M-‐F) from 8:00 am – 4:00 pm during: o June 1-‐5 or o June 8-‐12 or o June 15-‐19 or o June 22-‐26, 2015 2. Answer each question completely and truthfully.
3. Submit a high school report card with your application packet.
4. Provide the attached recommendation form and description above to a counselor, teacher, or
administrator from your high school. The recommendation form can be returned separately or with the
application.
Charlie Folsom, Jr., Director of UT SCORE
800 Madison Ave. Suite 309, Memphis, TN 38163
901-448-8289 phone 901-448-1357 fax [email protected]
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UT SCORE Application
APPLICATION DEADLINE: May 8, 2015
Please complete sections A-F below and enclose a copy of your high school report card. The report card must be included in order
for the application to be considered. You will also need to select a teacher or counselor who can complete the attached SCORE
Program Student Evaluation.
A.
Personal Data
Name:
Date:
(Last)
(First)
(M.I.)
Address:
Phone:
(City)
(State)
Date of Birth: _______________________
Age: __________
(Zip Code)
City/State of Birth: _______________________________
Student E-Mail (Required): __________________________________________________________________________________________
Parent/Guardian Name (Please Print): _______________________________________ Parent’s Phone:
Parent’s E-Mail (Required): __________________________________________________________________________________________
Race/Ethnicity: ___________________________________
Gender (circle)
Male
Are you eligible for fee waivers based on your parents’ income?
Female
Yes: ____
No:____
Did either of your parents graduate from a 4 year college bachelor’s degree program (check one)? Yes: ____
No: ____
Preferred Week (Please put a one by your first choice and two by your second choice. Note: A week will be assigned each student
based on availability.)
June 1-5 _____
June 8-12_____
June 15-19_____
June 22-26_____
B. High School Information
Name of Current High School: ____________________________
GPA:
Graduation year (circle one):
ACT (if applicable): __________
2020
2019
2018
2017
__________
Counselor Name: ____________________ Counselor E-Mail:_____________________________________
Applicants should return this completed APPLICATION with RECOMMENDATION and copy of their REPORT CARD
by May 8, 2015 to: Charlie Folsom, Jr., Director of UT SCORE, 800 Madison Ave. Suite 309, Memphis, TN 38163, 901-4481357 fax, [email protected].
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UT SCORE Program Student Evaluation
Applicant: please give this form to a teacher, guidance counselor, or school administrator who is familiar with your
personal qualifications for selection as a UT SCORE participant.
Applicant Name: __________________________________________________________________________________
I hereby (please check one) □ waive
□ do not waive
the right to examine this evaluation.
Applicant’s Signature: _____________________________________________________ Date: ____________________
Name of Evaluator__________________________________ Title of Evaluator________________________________
The person named above has applied to be a UT SCORE participant and has asked that you evaluate her/his ability to
successfully complete this pre-college preparation program. If the applicant has not waived the right to review this rating
form, you should consider it non-confidential.
How long have you know the applicant and in what capacity?
________________________________________________________________________________________________
Are there any factors that you are aware of that would allow or inhibit this applicant success in this college prep program?
(You may use the back of this sheet if you need additional space.)
________________________________________________________________________________________________
Please rate this candidate’s attributes by placing a check mark in the appropriate place.
Needs
Improvement
Adequate
Good
Superior
No Basis for
decision
Intellectual Ability
Oral Expression
Written Expression
Motivation/Initiative
Cooperation/Team Work
Emotional Maturity
Dependability
Creativity
Sensitivity to Diversity
Overall Potential
I ( ) highly recommend
( ) recommend with reservation
( ) do not recommend this applicant
Signature of Evaluator: ________________________________________________________ Date: ____________
Please return this form by May 8, 2015 to: Charlie Folsom, Jr., Director of UT SCORE, 800 Madison Ave. Suite 309, Memphis,
TN 38163, 901-448-1357 fax, [email protected].
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