Upward Bound - (AY) Student Update & Needs Form

Student Legal Name Student Legal Name First Last
Student Preferred Name Student Preferred Name First Last
Today's Date Today's Date / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Pronouns

Pronouns He/Him She/Her They/Them Other Other
School
Grade

Grade 9 10 11 12
Student Lives with:

Student Lives with: Mom Dad Grandparent Other Other
Parent/Guardian Name:
Parent/Guardian Phone: Parent/Guardian Phone: - ### - ### ####
Please fill your classes & teachers for each hour of the day.
1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) 9.)
Seniors & Extracurricular Scheduling Conflicts: During which course & for which teacher listed above would you prefer to meet during the school day?
Course: Teacher:
What is your favorite class or subject this year?
What is your least favorite class or subject this year?
What school classes do you think will cause you the most difficulty and why?
What FALL extracurricular activities do you plan to participate in? Include days of the week, times and start/end dates.
What SPRING extracurricular activities do you plan to participate in? Include days of the week, times and start/end dates.
Do you currently have a job?

Do you currently have a job? Yes No I am currently looking for a job
If you have a job, where do you work? How many hours are you working per week?
Do you work mostly to support your family?

Do you work mostly to support your family? Yes No
What is your T-shirt size?

What is your T-shirt size? S M L XL 2XL
Choosing a College

Choosing a College I have definitely decided on a college. I have a tentative college in mind but I am not yet ready to make a commitment to it. I am considering several possibilities but have not yet decided on a college. I am completely undecided about a particular college.
College Choice #1
College Choice #2
Selecting a Major

Selecting a Major I have definitely decided on a college major. I have a tentative major in mind, but I am not yet ready to make a commitment to it. I am considering several possibilities but have not yet decided on a major. I am completely undecided about a major.
Future Career Choice

Future Career Choice I have definitely decided on a career. I have a tentative career in mind, but I am not yet ready to make a commitment to it. I am considering several possibilities but have not yet decided on a career. I am completely undecided about a particular career.
Career Choice 1:

If unsure yet, you may put "Undecided"
I have researched this career and fully understand what it is. I know what my yearly/monthly salary could be. I have job-shadowed this career.
Career Choice 2:

If unsure yet, you may put "Undecided"
I have researched this career and fully understand what it is. I know what my yearly/monthly salary could be. I have job-shadowed this career.
Other Ways We Can Help You
Do you have a way to get to our events?

Do you have a way to get to our events? Yes No I have my own vehicle
What are 3 things that you would like to get out of UB this year?
1. 2. 3.
What are your academic and personal challenges that you feel that you are facing this year?
Are there any issues or things that you would like to share with your advisor that you need help with?

Upward Bound - (AY) Student Update & Needs Form

Upward Bound - (AY) Student Update & Needs Form

Other Ways We Can Help You