University Of New Orleans-Project Reach-UB-Application Form

Upward Bound

University of New Orleans - TRiO Programs
2000 Lakeshore Drive, ED 166, New Orleans, LA 70148

For questions, please call 504.280.6569

I am applying for Upward Bound (Project Reach)

Academics*

Rows	Yes	No
1. My GPA is below 2.5 on a 4.0 scale.
2. I need help in one or all core subjects.
3. I have limited English proficiency.
4. I want to know more about Dual Enrollment.
5. I want to enroll in AP or IB courses
6. I need to prepare for ACT testing.
7. I want to know about my career options.
8. I need to know more about high school graduation requirements.
9. I need to learn time management, study skills, and/or test taking strategies.
10. I am highly motivated about my education.
11. My ultimate goal is to achieve a college degree.

Please check the services you would like assistance with from the TRIO Program.*

Academic AdvisingCareer Development/AdvisingFinancial Aid/Financial Literacy AdvisingAbstract/Critical Thinking SkillsTutoringTransfer AdvisingStudy SkillsProfessional DevelopmentTime ManagementTeam BuildingStress ManagementTechnology EducationPersonal WellnessFamily Wellness PlanningDecision MakingCommunication SkillsCollege Awareness/SelectionTechnical Assistance with completing formsPreparing for ACT/SAT/EOC

In at least 250 words, please tell us why you deserve to be a part of this program and how it will benefit you in achieving your goals.*

0/400

Marital Status*

SingleDivorcedMarriedWidowLegal GuardianStudent is Emancipated
Mother's Name

First NameMiddle InitialLast Name
Mother's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Phone
(999)999-9999
Mother's Email
example@example.com
Has Mother received a 4-year degree from a college or university

YesNo
If yes, Name of University
Student lives with Mother*

YesNo
Father's Name

First NameMiddle InitialLast Name
Father's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Phone
(999)999-9999
Father's Email
example@example.com
Has Father received a 4-year degree from a college or university

YesNo
If yes, Name of University
Student lives with Father*

YesNo
Guardian's Name (Other than Mother or Father)

First NameMiddle InitialLast Name
Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian's Phone
(999)999-9999
Guardian's Email
example@example.com
What is Guardian's relationship to student

GrandparentAunt/UncleSister/BrotherLegal GuardianOther
Student lives with Guardian*

YesNo
Emergency Contact's Name (Other than Mother or Father)*

First NameMiddle InitialLast Name
Emergency Contact's Phone*
(999)999-9999
Emergency Contact's Email*
example@example.com

Household Information

Rows	Name	Age	Relationship to Applicant	Grade Level (if in school)	Indicate free or reduced lunch at school (if applicable)	Check if attending college	Check if employed
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