Education Service Center Region 12-Waco-UB-Pre-Application Form Logo

  • Upward Bound Program

    Pre-Application Form

  • The information requested in this form will be used solely for the purpose of determining TRiO Upward Bound student eligibility/desire of participation. The information will remain with Upward Bound and will not be released without the written authorization of the applicant and parent/guardian. Please keep in mind that this form is not the Upward Bound application. Students who complete and return this form will be notified (via email or phone call) if determined to meet eligibility criteria. Eligible students and their parents will have an interview (in person or by phone) with the Upward Bound Coordinator and will be given an Upward Bound application. If you have any questions, please call Stephanie Bailey at (254) 218-5971.

     

    PRE-APPLICATION COMPLETED BY STUDENT

    • Student Information 
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    • Student Citizenship Information 
    • Family Information 
    • Student School Involvement  


    • Education Achievements/Goals  

    • I certify that the information stated on this pre-application is true and correct to the best of my knowledge, and I grant permission to the Education Service Center Region 12 Upward Bound Program to access any and all of my educational records. All information obtained by the Education Service Center Region 12 Upward Bound Program will be used for eligibility verification and will remain confidential to the extent allowed. Participants are selected based on Upward Bound eligibility criteria without regard to gender, race, national origin, color, disability, or age. Legislative guidelines require participants are between the ages of 13 and 19, and have already completed the 8th grade.

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    • NOTE: Please include a copy of your most recent report card or transcript with this application.

      Send your information to:

      Stephanie Bailey, UB Coordinator Waco, (254) 218-5971

      sbailey@esc12.net

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