Upward Bound Program Application (Student Information Form)

To be completed by the student.

This is an application for consideration of acceptance into the Upward Bound College Preparatory Program. Completing this application does not guarantee acceptance.

Legal Name Legal Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent/Guardian Name that you live with
Student Phone Student Phone - ### - ### ####
Parent/Guardian Phone Parent/Guardian Phone - ### - ### ####
Birthdate Birthdate / MM / DD YYYY
Gender

Gender Male Female Non-Binary Other Other
Are you currently in Educational Talent Search?

Are you currently in Educational Talent Search? Yes No
Current Grade

Current Grade 8th 9th 10th 11th 12th
Expected Graduation Year
What grades do you typically earn?

What grades do you typically earn? A B C Below a C
School
What do you plan to do right after you graduate from high school? Check all that apply.

What do you plan to do right after you graduate from high school? Check all that apply. Attend a 4-year college Enroll in a technical/trade school Attend a community college for a 1 or 2 year degree Get a job Enlist in the military Other Other
What careers interest you?
How would getting accepted into Upward Bound help you meet your future goals?
As part of the application process, the Upward Bound Program requires you to ask a school staff member to submit a recommendation form for you. Who would you ask at your school to provide a recommendation for you?
Name
Occupation

Occupation Teacher Coach Counselor Social Worker Principal/Assistant Principal
How did you hear about the Upward Bound Program?

How did you hear about the Upward Bound Program? Teacher Coach Counselor/Social Worker Principal/Assistant Principal Class Presentation Current UB Student UB Staff Other Other
I certify that all information provided in this Upward Bound Program Application is accurate and true.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY

Upward Bound Program Application (Student Information Form)

Upward Bound Program Application (Student Information Form)

As part of the application process, the Upward Bound Program requires you to ask a school staff member to submit a recommendation form for you. Who would you ask at your school to provide a recommendation for you?

I certify that all information provided in this Upward Bound Program Application is accurate and true.