Upward Bound Math-Science Application

Student Application

Upward Bound Math-Science
Welcome to the online application for our TRIO Upward Bound Math-Science program at Sandburg! You can easily complete and then submit your application from most internet-compatible devices (computer, tablet, phone, etc.)!

Be sure to SAVE YOUR WORK as you progress through the application. (The option to save is at the bottom of each page).

Applications will remain open throughout the year with the possibility of enrolling students on an as-needed basis during the school year.

If you have any questions about this application, the application process in general, and/or our programs, please don't hesitate to contact us!

Upward Bound Math-Science

309.341.5278

ubms@sandburg.edu

www.sandburg.edu/UBMS

Thank you for considering our programs! We look forward to hearing from you!
Follow Sandburg Upward Bound Math-Science on social media!

PERSONAL INFORMATION
Student Preferred Name

First NameLast Name
Student Legal Name:

First NameLast Name
Student Birthdate:

MonthDayYear
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Cell Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Student School Email:
example@example.com
Student Personal Email:
example@example.com
Current Grade in School:
Gender:
Pronouns:
What is your T-Shirt size?
ELIGIBILITY
Are you a US Citizen or Permanent Resident?
Alien Registration Number (if a Permanent Resident):
Mark N/A if not applicable.
Are you a Disconnect Youth?
*Individuals between the ages of 14 and 24 who are homeless, in foster care, involved in the juvenile justice system, or are neither employed nor enrolled in an educational institution.
Do you have Limited English Proficiency?
*An individual whose native language is other than English and who has sufficient difficulty speaking, reading, writing, or understanding the English language.
What is the highest level of education achieved by your parent(s) or legal guardian(s)? If your parents are divorced, reply only in regards to the parent who has primary custody:
INCOME
Add up the total number of individuals in your household. The number should include yourself, parents, and siblings who are under the age of 24 if the parents provide more than half of their support. Also include other people if they now live with your parents and the parents provide more than half of their support. If your parents are divorced, include information for only the parent with whom you live (custodial parent) and step-parent if applicable.
What is the total number of people living in your household including yourself?
Please select the range that includes your family's household taxable income for the most recent tax year. Taxable income is reported on line 10 of the 1040 tax form.

PERSONAL STATEMENT INSTRUCTIONS
You must complete a personal statement as part of your application. This statement is your opportunity to explain how TRIO Upward Bound Math-Science will help you and how you can contribute to the program. This statement is also an opportunity for Upward Bound Math-Science to get to know you on a more personal level. Your personal statement will be evaluated for content, organization, creativity, and attention to detail.

Consider the following questions as you write:
- Why are you interested in Upward Bound Math-Science and what makes you a good fit?
- What obstacles may prevent you from getting into college? How can you overcome it?
- What are some of your academic weaknesses?
- What are you doing to strengthen your skills in these areas?
  How would you balance our program with other activities you may be involved in such as sports, work, church and family?
- Who inspires you to achieve your personal and academic goals?
- What are your goals for this upcoming year? (These can be academic or personal goals.) What is your plan of action to achieve these goals?
*Helpful tip: Type your personal statement in a word document (so you can save as you write) and then copy and paste it to the box below.
Personal Statement:

PERMISSION TO RELEASE INFORMATION
Student and parent signatures on this form thereby give the administrator(s), counselor(s), faculty or staff member(s) of the Jr. High School and High School of attendance of the below signed student permission to release current grade transcripts and/or test scores to representatives of the Upward Bound Math-Science program of which the below signed student has applied. This release will be kept on file in the Upward Bound Math-Science office.
Student Name:

First NameLast Name
Parent/Guardian Name

First NameLast Name
Name of Junior High:
Name of High School:
Student Signature:
Parent/Guardian Signature:

If a parent/guardian is not available at time of signature, please sign 'XX'; program staff will send this form to the parent/guardian to sign.
Date

MonthDayYear

TEACHER RECOMMENDATION
Please enter the name, school, and class of the teacher you would like to submit a recommendation for you, and we will send our recommendation form to that teacher. It would also be helpful if you can provide the teacher's email (if you have that information).

*Your Teacher Recommendation must be from an English, Math, or Science class you have taken with the teacher.
Teacher Name:

First NameLast Name
School:
Class Taught:
Teacher's Email:
example@example.com
PARENT QUESTIONNAIRE
Because you, the student, are applying to the program as a minor, we need to ensure we have your parental support. Please enter your parent/guardian's name and email so we may send them a parent questionnaire to fill out.
Parent/Guardian Name:

First NameLast Name
Parent/Guardian Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email:
example@example.com

SUBMIT YOUR APPLICATION!
Statement of Commitment
The Sandburg Upward Bound Math-Science program is 100% funded by the U.S. Department of Education to raise college entrance and graduation rates in Knox County. This is a year-round educational experience. UB Math-Science students are required to attend scheduled workshops, participate in program travel, attend after-school tutoring and participate in the six-week summer program held on the Sandburg campus.

My signature below indicates, to the best of my knowledge, the information provided on the UB Math-Science application is true, complete and accurate. I hereby authorize the Sandburg staff to obtain copies of my child’s academic and financial assistance records from the educational institution he or she is now attending and from educational institutions attended in the future.
Student Signature
View our non-discrimination/equal opportunity statement.
Parnet/Guardian Signature
Date

MonthDayYear
When you have completed all the required fields, click the "submit" button below.
Should be Empty:

Student Application

PERSONAL INFORMATION

ELIGIBILITY

INCOME

EDUCATIONAL PLANS & PROGRAM SERVICES

PERSONAL STATEMENT INSTRUCTIONS

PERMISSION TO RELEASE INFORMATION

TEACHER RECOMMENDATION

PARENT QUESTIONNAIRE

SUBMIT YOUR APPLICATION!

Statement of Commitment