City Of Seattle-DEEL-UB-Application Form

2026-27 UPWARD BOUND

APPLICATION FOR ENROLLMENT
STUDENT INFORMATION

(To be completed by student applying to Upward Bound)
1. Name:

First NameMiddle InitialLast Name
2. Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Mailing Address (if different):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Phone
(999)999-9999
5. Alternate Phone
(999)999-9999
6. Student Email Address (not SPS)
example@example.com
7. Social Security #:
999-99-9999
(Include a copy of social security card.)

Cancelof
8. Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
9. Age:
10. Gender:
11. Pronouns:
12. Anticipated Year of Graduation:
13. Current Grade Level:
14. School ID#
15. Current School:

Other (Please name):
16. What is your race/ethnicity?

Other
17. Citizenship (Please check):
Country of Birth:
Permanent Resident Card #
18. Do you participate in another pre-collegiate program?
If yes, please name:

Other college prep program:
19. What is your primary home language?

Other
Second language spoken in home
FAMILY INCOME

(To be completed by parent/guardian)
21. Estimated Annual Family Income (Please check the one that applies)
*These figures represent amounts equal to 150% of the family income levels based on family size and are established annually by the Census Bureau for determining poverty status. Federal TRIO Programs Current Year Low-Income Levels

22. Source of Income – Parent/guardian Information Mark all that apply.

Parent/Guardian 1

Rows	Yes	No
Employed
TANF (Temporary Assistance to Needy Families)
Social Security
Veteran’s Benefits
Unemployment Compensation
Other

Other: Please Describe

Parent/Guardian 2

Rows	Yes	No
Employed
TANF (Temporary Assistance to Needy Families)
Social Security
Veteran’s Benefits
Unemployment Compensation
Other

Other: Please Describe
23. If your family did not file a federal income tax return last year, check here
Will this year’s financial situation be significantly different from last year? If so, please explain.
FAMILY INFORMATION

(To be completed by parent/guardian)

24. I live with (please list all the people living in your home. If need, please attach another sheet with that additional information.

Rows	Name	Age	Relationship to you	Work	Highest Grade Completed
1
2
3
4
5
6
7

Have either of your parents earned a Bachelor’s Degree or higher?
25. Is your family homeless?
26. Parent Contact Information
Parent/Guardian 1
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:
(999)999-9999
Work Phone:
(999)999-9999
Cell Phone:
(999)999-9999
E-mail:
example@example.com
Parent/Guardian 2
Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:
(999)999-9999
Work Phone:
(999)999-9999
Cell Phone:
(999)999-9999
E-mail:
example@example.com
PROGRAM COMMITMENT
Student Commitment: If accepted into the program, I, {main_name} (student) commit to:

(Please initial each item)
Do my best to attain the personal, academic, and college prep goals that I set with my Upward Bound counselor.
Communicate regularly with my designated Upward Bound counselor.
Participate in Upward Bound Summer Academy at Seattle University during the first year of enrollment; and then each year after, participate in Summer Academy or participate in an alternative summer activity that supports my personal growth and development and prepares me to be college ready.
Take advantage of college tours, college admissions presentations, workshops, after school tutoring, and available resources to prepare me and inform my decisions regarding college.
Treat other Upward Bound students, staff, and myself with respect and to be a positive representative of the program.
Parent/Guardian Commitment: If accepted into the program, I {name58} (parent/guardian) commit to fully supporting my child’s application for admission to Upward Bound by:

(Please initial each item)
Participating, along with my student, in an enrollment interview and orientation session with the Upward Bound counselor.
Supporting my student’s participation in the Upward Bound Summer Academy at Seattle University.
Communicating with the designated Upward Bound counselor as needed to support my student’s success.
CERTIFICATION

We understand that Upward Bound is a federally funded program; and some or all of the information may be reviewed by or reported to the Department of Education other federal agencies or research firms. Information in all cases will be kept confidential to the extent required or authorized by local, state, and federal laws. The City of Seattle Human Services Department and the U.S. Department State of Education keeps the identity of individual students and their families confidential to the extent allowed by state and federal law.

Our signatures below indicate that to the best of our knowledge, the information provided in this application packet is true and correct and reflect our commitment to participation in the program.
Student Name

First NameLast Name
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
Parent Name

First NameLast Name
Parent Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
STUDENT INFORMATION

(To be completed by student applying to Upward Bound)
Please help us learn more about you by responding to the following questions. Your responses will be confidential.
1. What words best describe you? What strengths do you bring to Upward Bound and what contributions can you make to the program? (40-60 words)
2. What are your dreams and goals (college/career/general interests) and how do you think Upward Bound can help you achieve them? (40-60 words)
3. Do you think your grades/academics up to this point show your true potential? Why or why not? (40-60 words)
4. How do spend your time outside of school? What responsibilities do you have (with family, job or other programs)? (40-60 words)
5. Who or what has most influenced your decision to go to college? How? (40-60 words)

2026-27 UPWARD BOUND

STUDENT INFORMATION

FAMILY INCOME

FAMILY INFORMATION

PROGRAM COMMITMENT

STUDENT INFORMATION