Students must write an essay of 250 to 500 words. The essay will be used as part of a holistic review of the student’s application. Students should demonstrate effort and care on the essay. Essay should be TYPED and may be submitted electronically with this application.

Students must write ONE essay based on their situation:

HS FRESHMEN (Do not currently have a HS GPA): What makes education important to you? What are your education goals? How do you plan on achieving those goals?

HS Students with a 2.5 (C+) or higher GPA: Some students have a background, identity, interest, or talent that is so meaningful they believe their application would be incomplete without it. If this sounds like you, then please share your story.

HS Students with a GPA less than 2.5 (C+): Earning a college degree requires a strong commitment from students as well as high motivation. How will you motivate yourself to improve academically and prepare for college? What is your plan to improve your grades?

Directions. Complete this section for information of the student’s parents or current legal guardians. Please submit court documents with the application if you are a court-appointed guardian or foster parent for this student.

Directions. For the section on Biological or Adoptive Parent Information, include information, on the student’s biological or adoptive parents’ educational history only. Do not complete for court-appointed guardians or foster parents.

BIOLOGICAL OR ADOPTIVE PARENT INFORMATION. Please do not complete for court-appointed guardians or foster parents.

CONFIDENTIAL FAMILY INCOME INFORMATION

We are required by the U.S. Department of Education to obtain family income and other eligibility information from all participants served by the UBMS program. Please complete the following and submit documentation (e.g., Copy of Parents most recent Federal Tax Return, copy of SNAP Benefits statement, etc.) to the UBMS program office. All information is held in strict confidence used only for determining program eligibility. Your application will not be reviewed without the following information.

2. Please indicate your family’s taxable income. To determine taxable income (which may be less than your gross income) refer to the taxable income line on your most recent year Federal Tax Return.

I verify that by signing this document and submitting the requested documentation that the information which I have provided is accurate to the best of my knowledge. I understand that the UBMS program at Mount Wachusett Community College will hold this information in complete confidence.

I, {parentguardian1}, give my son/daughter/ward, {main_name} permission to participate in the Mount Wachusett Community College (MWCC) Upward Bound Math & Science (UBMS) Program. I also absolve MWCC, the UBMS Program, their personnel and the Athol, Gardner, Winchendon, and Monty Tech School Systems of any liabilities and claims arising from my child’s participation and attendance in the MWCC UBMS Program, including travel to and from such events and activities.

I consent to and authorize emergency and non-emergency medical care to be provided to my child in the unlikely event of as health problem, emergency or injury occurring during my child’s attendance in the UBMS program. I give my consent and authorization to appropriate UBMS members to use their judgement in seeking medical care for my son, daughter, or ward. I understand that an attempt will be made to contact me in the event that emergency medical care is needed.

I give permission for the UBMS program to obtain the academic records/information for the above named student throughout his/her high school career and for six years following their graduation to allow for annual tracking of UBMS participant’s education as required by Federal Department of Education to evaluate the UBMS program. I understand that his information will be held in compliance with FERPA and other applicable state laws and will only be accessible to appropriate program staff and Department of Education personnel.

I further give permission for the UBMS program to use pictures, video or audio recordings of the above-named student for all program related purposes, including for publication in newspaper and other media. If I do not wish for the UBMS program to use pictures, video and audio recordings of the above-named student I will submit written notification to the program and attach it to this application. This consent will remain in effect until its written revocation is received by the UBMS program at MWCC, 444 Green Street, Gardner, MA 01440.

Remind.com and Google Classroom

Students and Parents/Guardians will be asked to enroll in Remind.com and Google Classroom as part of the program. These will be the primary communication tools used for Community Announcements. By enrolling in Remind.com or Google Classroom you consent to be contacted by UBMS through those platforms. If, after enrolling in those platforms you choose to unenroll from those communications, please contact the UBMS Team through UBMS@MWCC.MASS.EDU.

As part of your application, you will need two recommendations: one from a guidance counselor and one from a teacher (MATH or SCIENCE teachers preferred). Please provide the name and contact information for the two individuals who will provide recommendations.