Regional Center for Math and Science      Regional Center for Math and Science

Student Reference Form

Dear Reference: The student requesting you complete this reference is applying for
participation in the Regional Center for Math and Science summer program at the University of
Wisconsin-Green Bay in Green Bay, Wisconsin. Before you complete this reference form you may find
the following program information helpful.

The Regional Center for Math and Science, RCMS, is a joint project of the
University of Wisconsin-Green Bay (UWGB) and the U.S. Department of Education.
RCMS resides inside the TRiO umbrella as an Upward Bound Math Science program.
RCMS at UWGB is one of one hundred twenty-four similar math and science programs
in the nation. We serve the following high schools, also listed on our website

Urban target high schools
  • Wayne Memorial HS, Detroit area (Wayne, MI)
  • Henry HS, Minneapolis, MN
  • South Minneapolis HS, MN
  • John Marshall HS, Rochester, MN
  • Century HS, Rochester, MN
  • Rufus King HS, Milwaukee, WI
  • Ronald Reagan HS, Milwaukee, WI
  • South Division HS, Milwaukee, WI
WI Rural target area schools
  • D.C. Everest HS, Central WI (Schofield)
  • Kaukauna HS, Northeast WI (Kaukauna)
  • Manitowoc Lincoln HS, Northeast WI
  • Little Wolf HS, North Central WI (Manawa)
  • New London HS, North Central WI
  • Sparta HS, Southwest WI
  • Stevens Point Area HS, Central WI
  • South Sheboygan HS, Eastern WI
  • Tigerton HS, North Central WI
  • Tomah HS, Southwest WI
  • Wausau East HS, Central WI
  • Wittenberg-Birnamwood HS, Central WI
The purpose of the program is two-fold:
1) to increase high school students' skills in math and science, and
2) to encourage them to prepare for professional careers in math and science.

RCMS is a six-week summer residential experience. Students live in university dorms,
eat in the dining hall, attend classes in the mornings, and participate in faculty
research projects in university laboratories in the afternoons. The RCMS program
includes weekly local field trips, weekend area field trips, and a weeklong stay at
an outdoor science education camp in Northwest Wisconsin. In addition, participants
engage in structured recreational and social activities. All student expenses, including
transportation to and from RCMS, are paid for by a grant from the U.S. Department of
Education. There are no costs to students.

Participation in RCMS is restricted to current high school sophomores and returning
juniors who meet federal and program eligibility criteria. Eligible students should
be motivated to follow a rigorous academic program for 6 weeks in the summer and have
the maturity, independence, and willingness to live away from home for 6 weeks in the
summer. Applicants will be chosen to participate in the RCMS program by a selection
committee. Committee members are anxious to select for participation students whose
opportunities for academic enrichment are limited and who have the potential to benefit
substantially from the educational and residential program offered by RCMS.

Last First
APPLICANT ID CODE (Required if submitting online)


Name of Reference


Phone Number

E-mail Address

Mailing address of Reference




Describe your relationship to the student. Mention how long you have
known the student, how well you know the student, and in what capacity you
know the student.

Comment on the academic abilities of the student, including attendance
and work habits.

Comment on the personal and social characteristics of the student.
Include information on maturity and independence.

Comment on how you think the student would fit into the RCMS program
and how he/she would benefit from the experience.

Please indicate below any of the statements that describe the student’s
need for a program like RCMS.

Areas of Need:
Low scores on state tests
Low high school GPA
At the beginning of 10th grade, had not successfully completed pre-algebra or algebra course
Low educational aspirations
Lack of opportunity, support, and/or guidance to take challenging college prep courses
Lack of career goals and/or need for accurate information on careers
Limited proficiency in English
Lack of confidence, self- esteem, and/or social skills
Predominately low income community
Rural isolation
Interest in careers in math and science
          Other Need (specify):
Comment on any reservations you might have in recommending this student
for the RCMS program.

Recommend with no reservations
Recommend with some reservations
I have strong reservations
          If you selected Recommend with some reservations - Please Explain:
          If you selected with STRONG reservations - Please Explain:
Please provide additional comments that you feel will assist the selection
committee with their decision to select the applicant for participation.