GEAR UP 2022 Student Check-in Assessment
GEAR UP Students ONLY-complete all the questions below.

You are a GEAR UP student if you attended the following schools at any time during the specified school year in the specified grades below. If you did not attend one of these schools during the specified year, please do not proceed. Thank you

School Year 2017 - 2018 (6th & 7th grade):
Douglas Byrd Middle School
Luther Nick Jerald's Middle School
Lewis Chapel Middle School
Westover Middle School

School Year 2018 - 2019 (7th & 8th grade)
Douglas Byrd Middle School
Luther Nick Jerald's Middle School
Lewis Chapel Middle School
Westover Middle School

School Year 2019 - 2020 (8th grade)
Douglas Byrd Middle School
Luther Nick Jerald's Middle School
Lewis Chapel Middle School
Westover Middle School


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Student Name *
Student Email Address (Personal Email) *
Student Phone Number *
Parent Name *
Parent Phone Number *
Street Address *
City *
State *
Zip Code *
Gender *
Grade *
School *
Are your parents in the military? *
What middle school did you attend? *
What time do you start your day? *
Time
:
Have you set up a schedule for yourself? *
Do you know how to access your  Google classroom materials at your school? *
Do you have any concerns with any of your classes? *
Are you having any challenges completing assignments on time? *
Are there any subjects you are having trouble with? *
Required
What type of device are you using to access your classes? * *
Required
Name your top career/occupation interests? *
Who/what/where do you want to work with/at when you graduate? *
Required
Name any of your top colleges or universities you would like to attend or tour? *
Have you ever had thoughts of dropping out? *
Do you feel you need emotional and/ social support? *
What additional activities/workshop topics interest you? *
Do you have any questions about the college application process? *
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