UPWARD BOUND PROGRAMS

(Classic)

Marquette University, 1303 W. Wisconsin Ave, Coughlin Hall Suite 225, Milwaukee, WI 53233

Office (414) 288-7368 | Email:ub@marquette.edu

The program serves low-income/first-generation students who reside in Milwaukee's central city as defined by zip codes 53205, -05, -06, -08, -09, -10, -12, -15, -16, -18 and 53233


Information about the Student

Last Name *
First Name *
Middle Name
Current school student attends? *
Current Grade *
Gender
Expected High School Graduation
Address Line 1 *
Address Line 2
City *
State *
Zip *
Home Phone
Cell Phone Number *
Student Email Address *
DOB *
Social Security Number
US Citizen *
Are you Hispanic/Latino?
Race (please answer all, 1=No, 2=Yes)
American Indian/Alaskan Native?
Asian?
Black or African American?
Native Hawaiian or Other Pacific Islander?
White?
Other?
With whom does the student live? *
If Other please specify
Parents/Guardians marital status

Mother/Legal Guardian Information
Name
Contact 1 Work Phone
Cell Phone
Best time to Contact
Is Mother Living?
Has Mother/legal Guardian Earned a 4 Year College Degree?

Father/Legal Guardian Information
Name
Work Phone
Cell Phone
Best Time to Contact
Is Father Living?
Has Father/Legal Guardian Earned a 4 Year College Degree?

Financial Information
Did the parent(s) file an Income Tax Return for Tax Year 2020?
What was your Taxable Income for the Tax Year 2020?
For Form 1040 this is line 43; for Form 1040A this is line 27; for Form 1040EZ this is line 6. if you were not required to file a Federal Return your Taxable income is $0.
Total Number of members in household

The information contained in this application is for the use of the Upward Bound Programs at Marquette University only and will be held in the strictest confidence. All records are kept in secure locked storage.

By signing below, you certify that all information contained in this application is correct, complete and accurate (this includes the educational attainment level of both parents, financial information, size of household, etc.) to the best of your knowledge.

Parent Guardian Signature
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Signature: (Type in your full name)
I agree to the terms included.

AUTHORIZATION FOR RELEASE OF EDUCATIONAL RECORDS & ADDITIONAL RELEASES

Please read the following information before signing. All information will be kept confidential.

I hereby grant authorization for my educational records (grades, transcripts and test scores) to be released by the middle school, high school, district, and/or college to the Upward Bound Programs at Marquette University (MUUB). I understand that the Upward Bound Programs will request grades at the conclusion of each grading period and transcripts/test scores at least annually. I furthermore agree that Marquette University’s Educational Opportunity Program’s (EOP) Pre-College Division will also maintain records of performance in program classes and activities. EOP Pre-College Division may share academic information regarding participation in the Upward Bound Programs (grades, test scores, etc.) with my parents and/or high school.

I also authorize Marquette University’s Educational Opportunity Program’s (EOP) Pre-College Division to use photographs and/or videotape with my image in Upward Bound publications and/or news releases.

Permission is granted for the student to participate in all activities sponsored or attended by MUUB. Permission is granted for Upward Bound staff members to transport the above-named student to and from these activities.

Permission is granted to provide counseling services to the above-named student as necessary by the appropriate University and/or community resources (i.e. University Counseling Service).

We understand that the Upward Bound Programs are for students who are able to handle the responsibility of being away from home for the residential summer component.

We recognize that Upward Bound Programs are a major investment by the United States Department of Education and we understand that if the student is accepted and wishes to attend, he or she will be expected to fully participate in the program (both during the academic year and summer) and student not taking vacation or trips during the 6-weeks of the UB summer programming.

We understand that if MUUB accepts the applicant, he or she will have to adhere to the program’s rules and regulations concerning student responsibility and behavior in the academic and residential life programs. We understand that the Upward Bound Director will have the right to dismiss any student whose behavior is incompatible with the goals and standards of MUUB.

We agree that the student, if accepted into MUUB, may participate in answering questionnaires and other appropriate and approved research projects done as a part of the program's evaluation.

If you are a current 8th grade student, what is your prospective high school?
Student's career goals *
Is student in any other pre-college program, if yes which program(s)? *
Please list the name of a teacher (only list teacher of these subjects: English, math, social studies, or science) and the student’s school counselor who will be providing the recommendation for this student:
Teacher *
Subject *
Email
Counselor *
Counselor Email
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Click here to start signing.
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Signature: (Type in your full name)
I agree to the terms included.
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