Prospective UB Interest Form 2021

Upward Bound Interest Form

Thank you for your interest in being in Upward Bound. Before being enrolled in Upward Bound, you must successfully complete a 60-day probation period with either at or above 80% attendance. You are able to choose whether you want to start your probation period during the summer or the fall.

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* 1. Student Contact Information

Name (First & Last)

Address

City/Town

ZIP/Postal Code

Shirt Size (Adult Unisex)

Personal Email Address

Cell Phone Number

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* 2. Parent/Guardian Contact Information

Parent/Guardian Name (First & Last)

Parent/Guardian Email Address

Parent/Guardian Cell Phone Number

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* 3. Parent/Guardian Education Information

One or both of my parents/guardians attended a 2 year college.

One or both of my parents/guardians attended a 4 year college but did NOT graduate.

One or both of my parents/guardians attended a 4 year college AND graduated.

One or both of my parents/guardians did NOT attend any college.

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* 4. Are you still interested in being part of Upward Bound?

Yes, I am still interested.

No, I am no longer interested.

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* 5. If you are interested in being in Upward Bound, please state when you would be interested in starting your 60 day probation period.

I would like to start my 60 day probation period this summer (June-July)

I would like to start my 60 day probation period this fall (Aug-Sept)

Student Information

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* 6. Class Level

Class of 2022

Class of 2023

Class of 2024

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* 7. Are you planning on attending summer school?

Yes I am attending summer school.

No I am not attending summer school.

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* 8. If you are attending summer school, please list the days and times. Ex: Mon/Fri 12:00-1:00

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* 9. Are you working this summer or planning on working?

Yes I am working or I plan on working.

No I am not working and do not plan on working.

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* 10. If you are working or plan on working, please list the days and times. (ex: Mon-Thurs 12:00-1:00pm)

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* 11. What topics/experiences are you interested in learning more about:

Academic Tutoring

Help in preparing for ACT/SAT

Financial Aid Assistance/ Scholarship Help

College Selection Help

Study Tips

Leadership Development

College Exposure

Other (please specify)

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* 12. What career fields are you interested in learning more about? (Select all that apply)

Architecture and engineering (ex: Architect, Civil engineer, Biomedical engineer, etc)

Arts, culture and entertainment (ex: Graphic designer, Filmmaker, Interior designer, etc)

Business, management and administration (ex: Real estate agent, Marketing, Entrepreneur/small business owner, etc)

Communications (ex: Journalist, Public relations specialist, Meeting/event planner, etc)

Community and social services (ex: School counselor, Licensed clinical social worker, Rehabilitation counselor, etc)

Education (ex: Teacher, After school program director, Superintendent, etc)

Science and technology (ex: Software engineer, Computer scientist, IT analyst, etc)

Installation, repair and maintenance (ex: Auto mechanic, Plumber, etc)

Farming, fishing and forestry (ex: Agricultural worker, Forest and conservation worker, etc)

Health and medicine (ex: Nurse, Veterinarians, Physical therapist, etc)

Law and public policy (ex: Paralegal, Lawyer, Criminal justice, etc)

Other (please specify)

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* 13. What subject areas do you need the most help/ assistance/ tutoring in?

Math

Foreign Language

Pre- Calculus

English

Biology

Chemistry

Physics

Other (please specify)

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* 14. What are your plans for after high school?

Enroll in a college/university

Go to trade school

Get a full time job

I'm not sure yet

Other (please specify)

Prospective UB Interest Form 2021

Upward Bound Interest Form

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* 1. Student Contact Information

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* 2. Parent/Guardian Contact Information

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* 3. Parent/Guardian Education Information

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* 4. Are you still interested in being part of Upward Bound?

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* 5. If you are interested in being in Upward Bound, please state when you would be interested in starting your 60 day probation period.

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* 6. Class Level

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* 7. Are you planning on attending summer school?

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* 8. If you are attending summer school, please list the days and times. Ex: Mon/Fri 12:00-1:00

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* 9. Are you working this summer or planning on working?

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* 10. If you are working or plan on working, please list the days and times. (ex: Mon-Thurs 12:00-1:00pm)

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* 11. What topics/experiences are you interested in learning more about:

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* 12. What career fields are you interested in learning more about? (Select all that apply)

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* 13. What subject areas do you need the most help/ assistance/ tutoring in?

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* 14. What are your plans for after high school?

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* 15. What major(s) are you interested in?

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* 16. What career(s) are interested in?

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* 17. What college(s) are you interested in?

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* 18. Please list some of your hobbies, interests, activities, and/or clubs you're involved in.

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* 19. What would you like to gain from becoming a UB student?