GEAR UP Claim Entry Form DistrictDistrict 1District 2District 3Select a school, District 1School 1School 2School 3Select a school, District 2School 1School 2School 3Select a school, District 3School 1School 2School 3Does this include an entire grade?* No Yes Grades Served 10 11 12 13 Write the names of students who were absent.District 1 School 1*Student 1Student 2Student 3District 1 School 2*Student 1Student 2Student 3District 1 School 3*Student 1Student 2Student 3District 2 School 1*Student 1Student 2Student 3District 2 School 2*Student 1Student 2Student 3District 2 School 3*Student 1Student 2Student 3District 3 School 1*Student 1Student 2Student 3District 3 School 2*Student 1Student 2Student 3District 3 School 3*Student 1Student 2Student 3If you couldn't find the student, write: Last name, First name, Student ID Select the Service* 21st Century Scholars 529 Savings Account ACT/Pre-ACT Prep ACT Retakes ASPIRE Day-Financial Aid ASPIRE Day-Counseling ASPIRE Day-College Visit Career Fair College Application Week-Financial Aid College Application Week-Counseling College Decision Day College Visit Counseling Advising Credit Recovery Financial Aid Finish the FAFSA GEAR UP for College Week-Financial Aid GEAR UP for College Week-Counseling Information Distribution-Academic Counseling Information Distribution-Finance Mentoring Post Secondary-BOT Post Secondary-General Senior Day-Financial Aid Senior Day-Counseling Summer Programs Tutoring/HW Assistance-Math Tutoring/HW Assistance-English Tutoring/HW Assistance Both Math & English Tutor.com-Math Tutor.com-English HiddenFA (Hidden)Financial AidHiddenMentoring (Hidden)MentoringHiddenCounseling Advising (Hidden)Counseling AdvisingHiddenPost-Secondary (Hidden)Post-SecondaryHiddenTutoring (Hidden)TutoringHiddenSupportive Services (Hidden)Supportive ServicesHiddenCollege Visit (Hidden)College VisitHours of service (whole number)*Minutes of service (whole numer)*Date the service took place* MM slash DD slash YYYY ModalityFace-to-FacePhoneVirtualMediaHow many family members were present?What is the Cover Sheet ID number?*Initials* Notes