Upward Bound Program

Student Application For Admission

 

Each question must be answered for this application to be processed.
Student's Name: ( First, Middle, and Last Name) *
DOB *
Age *
Sex *
Are you a U.S. Citizen or Permanent Resident? *
The University of New Mexico is required by Federal law to request this information for statistical reporting purposes. Your response is voluntary. 
Do you consider yourself Hispanic/Latino? *
In addition, select one or more of the following ethnic categories to describe yourself: 
American Indian/ Alaskan Native
Your principal tribe:
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White

Definitions:

  • Hispanic or Latino: A person Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. 
  • American Indian or Alaska Native: A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment. 
  • Asian: A person having origins in any of the original peoples of the far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malausia, Pakastan, the Philippine Islands, Thailand, and Vietnam. 
  • Black or African American: A person having origins in any of the black racial groups of Africa. 
  • Native Hawaiian ir Other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 
  • White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. 
Mailing Address: (Street, city, state, and zip code) *
Home (physical) Address (Street, city, state, and zip code): *
Please provide two telephone numbers where you can be contacted:
Please select one: *
Please select one: *
High School *
Grade *
Counselor *
Father's Name
Occupation
Father's address (if different from yours):
Father's Phone number
Father's Employer:
Employer's Phone:
Mother's name:
Occupation:
Mother's address (if different from yours):
Mother's Phone number
Mother's employer:
Employer's Phone:
Whom do you live with? Two parent household (Mother & Father), single parent or other? 
Please specify (Do you have any parenting plans or living arrangements we should be aware of): *
Full name of Legal Guardian, if not Mother/Father
Relationship:
Address of Legal Guardian:
Legal Guardian phone number
Occupation of Legal Guardian:
Employer:
Address of employer:
Employer's Phone number
Parent's education level: 
Father:
Mother
Legal Guardian
Please list every person living in your home: (including yourself) *
People financially supported by your parent or guardian who are not living in your home. *
Has an older sibling participated in any UPWARD BOUND program? *
Number of siblings who:
Are currently attending college: *
Attended college, but dropped out: *
Graduated from college *
Upon graduation from high school, what are your plans: *
List in order of preference, your career interests:
1st. *
2nd *
3rd. *
Why are you interested in participating in UPWARD BOUND? *
In what extracurricular or volunteer activities do you participate in school (including athletics)?
A.
B.
C.
D.
Check any of the following that your family receives:
Food Stamps
TANF
Social Security Benefits
SSI
Veterans Benefits
Medicaid
Other
Specify:

********* NOTE *********

VERIFICATION WILL BE REQUESTED FOR ANY OF THE ABOVE WHICH YOU RECEIVE.
Who referred you to Upward Bound? *

Please check to see if this application is true, correct and complete!

I hereby affirm that the information reported on this form and any attachment hereto is true, correct, and accurate to the best of my knowledge. 
Signature of Student: *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Date: *
Name of Student: *
Signature of Parent or Legal Guardian: *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Date: *
Name of Parent or Legal Guardian *