Upward Bound Program Application (Academic Records & Request Form)
Upward Bound Program Application (Academic Records & Request Form)
I give my permission for John Wood Community College Upward Bound personnel to obtain my records from the following high schools: Quincy Junior High School, Quincy Senior High School, Meredosia-Chambersberg High School, Griggsville-Perry High School, Pittsfield Junior High School and Pittsfield Senior High School. If your school is not listed, please include at bottom of form.
Student Name
Student Name
*
First
Last
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.
Parent/Guardian Name
Parent/Guardian Name
*
First
Last
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.
Student Birthdate
Student Birthdate
/
MM
/
DD
YYYY
School Name
Last Four Digits of Student's SSN
Today's Date
Today's Date
*
/
MM
/
DD
YYYY