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Upward Bound Interest Form
Please complete this form if you are interested in receiving information about our Upward Bound Program.
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* Indicates required question
Student Full Name:
*
Your answer
STUDENT Phone Number:
*
Your answer
Student Personal Email Address: (Please do not provide school email)
Your answer
Parent/Guardian Full Name:
Your answer
Parent/Guardian Phone Number:
Your answer
Mailing Address:
Please enter your full mailing address, including street address, apartment # (if applicable), city, state and zip code
Your answer
Current Grade in School:
9th Grade
10th Grade
11th Grade
12th Grade
Other:
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Current Enrollment:
Brawley Union High School
Calexico High School
Calipatria High School
Central Union High School
Imperial High School
Holtville High School
Southwest High School
Other:
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Current GPA:
Your answer
Current Math Class
Your answer
Citizenship
U.S. Citizen
Resident Immigrant
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Has father/mother earned a bachelor's degree?
Yes
No
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Are you a Talent Search Student?
Students enrolled in this program are
NOT
eligible for the Upward Bound Program
Yes
No
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