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1. Student Applicant Information

Marian University's UBMS program is a federally funded TRIO educational program. We are required to determine whether our applicants meet the criteria of first-generation college and/or financially qualified status prior to their acceptance into the program. The information collected via this form will be kept confidential. Upon reception of this application, a member of the team will contact you to collect additional information that may be needed as part of this process.

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* 1. Student Name: First, Middle Initial, and Last

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* 2. Contact Information

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* 3. Sex at Birth *

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* 4. Ethnicity *Not Required

This information is being requested in accordance with Federal regulations. The information is voluntary and will not be used when considering you for acceptance into the UBMS program.

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* 5. Do you have a documented disability?

If you have a documented disability, UBMS staff will follow up with you for additional information.

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* 6. Residency Information

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* 7. High School Information

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* 8. Grade Level

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* 9. What is your GPA?

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* 10. School Counselor Contact Information

PROGRAM ELIGIBILITY CRITERIA

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* 11. First Generation Status.
A first generation college student is one whose neither parent has received a Bachelor's degree or higher at the time of entry into the UBMS program.

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* 12. Father's highest level of education

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* 13. Mother's highest level of education:

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* 14. Income Status
Following the submission of this form, parent(s)/guardian(s) will be contacted for verification of income.

To verify income status, a signed copy of parent(s)/guardian(s) Income Tax Return (Form 1040, 1040A, or 1040EZ) for the calendar year preceding this year will be requested. If this is not available, parent(s)/guardian(s) will be asked to sign a statement regarding their  student's eligibility based on their income level . The income to be considered is the taxable income of the household that has custody of the student. 

For any question about this section of the application form, please be in contact the the UBMS program to determine eligibility to the program. 

The application process is not considered complete until this information has been received by the UBMS staff.


STUDENT INTERESTS QUESTIONNAIRE

INSTRUCTIONS: Please answer the following questions using complete sentences. Considerable thought and effort should be given to the responses.

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* 15. Why do you want to participate in UBMS?

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* 16. What career do you want to have when you graduate from college?

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* 17. What is your greatest academic challenge?

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* 18. What is one thing you have done that you are most proud of?

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* 19. What do you want to study or major in when you go to college?

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* 20. Who encourages you the most to take challenging classes?

EXTRACURRICULAR ACTIVITIES QUESTIONNAIRE

INSTRUCTIONS: Please answer the following questions, using complete sentences. Considerable thought and effort should be given to the responses.

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* 21. Please list school, community clubs, organizations, sports that you are currently involved in.

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* 22. Please list jobs or volunteer work you have done. Include church, community service, and school or family jobs. What did you learn from these experiences?

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* 23. Describe your special interests and hobbies, what do you like to do after school or on weekends?

PARENT/LEGAL GUARDIAN INFORMATION

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* 24. Mother/Guardian information

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* 25. Father/Guardian Information

EMERGENCY CONTACT INFORMATION 

Please provide the information for three contacts, in addition to parents/legal guardians listed above.

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* 26. Emergency Contact #1

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* 27. Emergency Contact #2

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* 28. Emergency Contact #3

RECOMMENDATION FORMS
Recommendation forms are very important components of your application to the UBMS Program. Therefore, you must submit three recommendation forms. One of these recommendations must be from a school counselor, administrator, or student services staff member, and the remaining must be by one previous or current teachers (at least one of them must teach science or math).

You are highly encouraged to speak directly to your prospective recommenders about your interests in applying for the UBMS Program. This would help them adequately assess your potential to succeed as a participant.

For administrative records, please indicate the names of the teacher and the school counselor who will recommend you to the UBMS Program.

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* 29. Two recommendations in support of your application. 
Include one of each of the types listed below:

STUDENT AND PARENT(S)/GUARDIANS APPROVAL AND SIGNATURE

Please understand that Marian University's Upward Bound Math and Science administrative staff respects the confidentiality of each applicant as well as their family. Considerable care is taken to ensure that personal and family information is not publicly accessible.
  • We understand that the Marian University Upward Bound Math and Science program will use the data provided on this application for to assist in assessing the student’s academic and career planning needs.
  • We understand that all information provided on this form will be kept and used in the strictest confidence.
  • We certify that all information provided on this form is correct to the best of our knowledge.
  • By submitting this form, we give permission for Marian University's UBMS staff to access the aforementioned student’s academic records and give permission for any school that our student attends to release those records to UBMS Staff. The information will be used to determine student eligibility and potential for success in the project.
  • By submitting this form, we agree to be contacted by a Marian University staff who will collect all the required signatures necessary for this process..
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