University Of Texas-Arlington-UB 1-Application Form

Upward Bound Student Application

University of Texas- Arlington
Welcome to the FIRST step on your journey to be considered for UTA Upward Bound – TRIO. To read more about UTA Upward Bound, please visit our website HERE.

This application will take you approximately 15-30 minutes to complete. If you are not able to complete in one sitting, you may save your progress and log back in with your email. Simply click the “Save” button at the bottom of the page.

The application will ask for submission of documents such as
- Recent Report Card
- Recent STAAR Test Scores
If you are having trouble with the application or need help, feel free to email us at upwardbound@uta.edu.
Student Name:*

First NameLast Name
Student date of birth*

MonthDayYear
mm-dd-yyyy
Please enter your school ID number (issued by your current school campus):*
Gender*

MaleFemalePrefer not to disclose
What is your current status?*

U.S. CitizenPermanent ResidentOther
Are you of Hispanic/Latino/Spanish origin?*

YesNo
How would you best describe yourself?*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Current HOME Mailing Address (Street address, Apt or unit #) (Not your email)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email Address*
example@example.com (Please add your email that you check DAILY.)
Student Cell Phone Number*
(999)999-9999
Current Grade Level*

8th9th10th11th12th
Which of the following high schools do you currently attend or will be attending in the Fall of your freshmen year?*

Sam Houston HSGrand Prairie HSOther
Expected Graduation Date*

May/June 2026May/June 2027May/June 2028May/June 2029
Counselor's Name: (check your school’s website to determine your assigned counselor)*

First NameLast Name
Have you ever faced major disciplinary action in school?*

YesNo
Briefly explain the reason you faced disciplinary action and the outcome of the action:*
Describe yourself in 5 sentences. *
What are your goals after high school? (3-5 sentences) *
What are you looking forward to if you join Upward Bound – TRIO? (4-5 sentences) *
Check all of the following services that interest or may benefit you:*

English TutoringReading TutoringMath TutoringScience TutoringSpanish TutoringWriting TutoringPSAT/SAT PrepACT PrepStudy/ Test Taking SkillsCultural ActivitiesLeadership ActivitiesSocial/Life SkillsAcademic AdvisingCollege ToursCollege Admissions AssistanceCollege Financial Aid AssistanceCollege Survival SkillsProfessional Development/Mentoring
Parent/Guardian #1 Full Name:*

First NameLast Name
Please ensure this number and email is correct, as your parent will be contacted to submit an application, as well!
Parent/Guardian #1 Phone Number*
(999)999-9999
Parent/Guardian #1 Email Address*
example@example.com
What is your parents'/guardian's preferred language?*

EnglishSpanishOther
What level of education has Parent/Guardian #1 Received?*

Some High SchoolHigh School GraduateSome CollegeCollege GraduateSome Graduate School (Masters)Completed Graduate School (Masters)Doctoral Degree (PhD)
Do you have a second parent/guardian who is an active part of your life and would like to be listed as a contact?*

YesNo
Parent/Guardian #2 Full Name:*

First NameLast Name
Parent/Guardian #2 Phone Number*
(999)999-9999
Parent/Guardian #2 Email Address*
example@example.com
What level of education has Parent/Guardian #2 Received?*

Some High SchoolHigh School GraduateSome CollegeCollege GraduateSome Graduate School (Masters)Completed Graduate School (Masters)Doctoral Degree (PhD)
With Whom Do You Live? Check all that apply and List relationship for additional household members):*

MomDadGuardian
Guardian Relationship

Please list all family members living in the home (ex: Brother, two sisters, etc.)

Rows	Name	Family Relation (ex: sister, brother…)	Age
1.
2.
3.
4.
5.
6.
7.
8.

How did you hear about Upward Bound?*

TeacherCounselorSocial Media SiteUTA WebsiteUTACommunity Activity/EventGoogle SearchUpward Bound StudentOther
What is the Upward Bound Student Name?*

First NameLast Name
Are you a member of any of the following programs:*

TRiO Educational Talent SearchGear Up!TRiO Upward Bound Math and ScienceAVID (Advancement Via Individual Determination)Free or Reduced LunchI am not a member of any of these programs
STUDENT SIGNATURE: Please sign (using your mouse/cursor as a pen) that you have provided us with accurate, truthful information in regards to your application and you understand that Upward Bound at UT Arlington may contact you and/or your parents/guardians for further information?*

Clear
You will need two recommendations from either a Core Subject Teacher or HS Counselor.

You will receive an email after you submit your application , please share the link with them to submit a recommendation form on your behalf!

We will need BOTH of your recommendations surveys to continue to the next step!
What is the email of a current teacher who knows you and your character?*
example@example.com
What is the email of your current school counselor? (check your school website for this information)*
example@example.com
Please upload an image or screenshot of your most recent report card. Your name must be visible in the image.

Cancelof
Please upload a copy of your most recent STAAR Test Scores. Your name must be visible in the image.

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Students will be contacted by Educational Advisors about the status of their completed application. Our staff is available to provide assistance or answer any questions regarding the application process. Reach out to us at upwardbound@uta.edu or at 817.272.2610.

While we cannot accept every student, we promise to evaluate each applicant who is eligible for the services we provide and will contact applicants about their status.

The University of Texas at Arlington – Legal and Privacy Notice.

Upward Bound Student Application