Upward Bound Interest Form
Thank you for your interest in joining the UC Riverside Upward Bound Program! Please fill out the following survey to receive a copy of the application via email.

To learn more about the Upward Bound (UB) program, please visit: https://trioprecollege.ucr.edu/ 

If you have questions, please email, text, or call a UB staff member.

Moreno Valley, Perris, & Rubidoux students contact:
Oscar Hinojosa
(951) 255-1582

Banning, Norte Vista, & Ramona students contact:
Rudy Curiel
(951) 255-1523

Bloomington, Colton, & Eisenhower students contact:
Daniela Coronado
(951) 202-5461

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What is your First Name? *
What is your Last Name? *
What high school do you attend? *
What grade are you in? *
Do you qualify for free or reduced lunch? *
Do either of your parents have a 4 year college degree (Bachelor's Degree). *
What is your Student ID Number? *
What is your school email address? *
Please provide the email your school assigned to you.
What is your personal email address? *
Please provide a personal email address you've created and have access to. Ex. a Gmail or Yahoo address.
What is your cell phone number? *
If you don't have a cell phone number please type "N/A" below.
What is your Parent or Guardian's First and Last Name? *
Please provide the contact information for the parent/guardian that will sign your application.
What is your Parent or Guardian's phone number? *
What is your Parent or Guardian's email address? *
If your Parent or Guardian doesn't have an email address please type "N/A" below.
What is the primary language spoken at home? *
How did you hear about Upward Bound? *
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