EmailMe Form - ABAC Upward Bound Interest Form

PART ONE: STUDENT & GUARDIAN INFORMATION
Student Name: *
First Middle Last
Student Date of Birth: *
month/day/year
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Student Gender *
male
female
other
If you answered "other" to the previous question, please list your preferred gender pronouns below:
Student Age: *
Student Race/Ethnicity: *
Black/African-American
Hispanic/Latino
White
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Other
Student Email (NOT school email):
Name of School Student Attends: *
High School Status: *
Freshman (9th)
Sophomore (10th)
Junior (11th)
Senior (12th)
Phone Number(s): *

Parent/Guardian #1 Phone:

Parent/Guardian #2 Phone:

Student Phone:
Can we call AND text any of the numbers above? If so, which one(s)? *
Parent/Guardian Name: *
First Middle Last
Parent/Guardian Email:
PART TWO: ELIGIBILITY
The following questions help determine the applicant's eligibility for Upward Bound. This will require parental/guardian input.
*In addition to the information required now, you must later submit a copy of your signed tax return to verify student eligibility in accordance with federal regulations.

*If you did not file income tax, please submit a signed letter stating that you do not file taxes, what your annual household income is, and from what sources that income is received. In addition, please submit document(s) (Social Security statements, Child Support statements, etc.) to verify total income as listed in the letter.
PARENT/GUARDIAN: Please refer to your 2021 tax returns and report your taxable income amount below. This should be line 15 on your returns. *
PARENT/GUARDIAN: Please record the number of individuals currently in your household, including yourself: *
FIRST-GENERATION ELIGIBILITY: *

YES NO

MOTHER HAS FOUR-YEAR COLLEGE DEGREE

FATHER HAS FOUR-YEAR COLLEGE DEGREE
Are you a U.S. citizen or U.S. permanent resident? *
Yes
No
Not sure
Parent/Guardian Signature: Please use mouse to sign.
Clear
PART THREE: NEXT STEPS OF APPLYING
After submitting this online form, a letter and additional documents will be mailed to the address provided above. Please take the time to complete and sign the mailed documents, as well as provide a required copy of tax returns or income information.

Once Upward Bound staff receives the tax copy and signed/completed documents, they can make a decision regarding program acceptance for applicants.

A student/parent interview will later be required for any accepted applicants. The interview can be conducted in-person or virtually based on interviewee's preference.

Thank you for submitting - we look forward to speaking with you soon!

Parent/Guardian #1 Phone:
Parent/Guardian #2 Phone:
Student Phone:

	YES	NO
MOTHER HAS FOUR-YEAR COLLEGE DEGREE
FATHER HAS FOUR-YEAR COLLEGE DEGREE

PART ONE: STUDENT & GUARDIAN INFORMATION

PART TWO: ELIGIBILITY

PART THREE: NEXT STEPS OF APPLYING