New Student Application Upward Bound Math & Science

Please attach a copy of one of the below documents showing proof of citizenship and residency.

1. Immigration and Naturalization Service documentation of intent to establish permanent residency
2. Certificate of Indian Blood (CIB), Bureau of Indian Affairs Card Number or Tribal Enrollment Number
3. Birth Certificate showing applicant was born in the United States or U.S. passport (current or expired)

 I {parentName}, the adult parent or legal guardian, acknowledge that double or multipleoccupancy may occur during the [Upward Bound Math Science Program] for travel and/or on-campus residency sponsored by Northern Arizona University (university). I understand the risks of a Non-Student Minor sharing a room with other Non-Student Minors, and I acknowledge that I have had a chance to read the university's Sexual Misconduct Policy. Knowing this, I voluntarily assume the risk and choose to have the Non-Student Minor participate in the Program.

Certification: All of the information on this application is true and correct to the best of our knowledge. If asked by an authorized official, we agree to give proof of the information that we have given on this application. The Upward Bound Math & Science program at Northern Arizona University is required by federal law to report cases of suspected fraud to appropriate law enforcement agencies for investigation.

Head of Household: check all for which you qualify

Sources of Income
- If you are married, and filed jointly, include your spouse’s income.
- Enter a dollar amount in every box.
- Enter a zero in each category where no income was earned.

*State all other sources of income below (attach additional sheet if necessary).

Parental/Guardian Consent: I give my permission to any, and all, public assistance programs to release the necessary information to verify the above income (i.e., Social Security Benefits Programs, Food Stamps, School Lunch Programs, and/or Welfare/General Assistance Programs).

Thank you for encouraging your child to apply to the UBMS Program. Answer each question honestly and with exact details when possible. Attach additional sheets if necessary.

First-generation status

UBMS defines first-generation as meaning, neither parent/guardian have a four-year college degree or higher. If you, the parent/guardian, attended a four-year college, but did not complete the degree, your child is still considered a firstgeneration student.

I, {main_name} (Student’s name), hereby consent to the release of my academic records, including but not limited to, transcripts, grade reports, test scores, course evaluations, attendance records, recommendations and other information regarding my school performance to-- Northern Arizona University Upward Bound Math & Science Program. This release is to be effective throughout my high school, and college career and includes my final transcripts upon graduation from secondary school and college. It is effective regardless of whether or not I am actively involved with Upward Bound Math & Science at the time of the records request.

As the parent/guardian of {main_name} (Student’s name), I hereby consent to the release of my child’s academic records – including but not limited to transcripts, grade reports, test scores, course evaluations, attendance records, recommendations and other information regarding their school performance to-- Northern Arizona University Upward Bound Math & Science Program. This release is to be effective throughout their high school, and college career and includes their final transcripts upon graduation from secondary school and college. It is effective regardless of whether or not they are actively involved with Upward Bound Math & Science at the time of the records request.

Must be completed by the student applicant. Check “Yes” or “No” to each question.

I, {main_name} (Student’s Name), agree that if I am accepted to the Upward Bound Math & Science Program at Northern Arizona University, I will:

1. Abide by all rules and policies of UBMS, program partners and Northern Arizona University.
2. Work to maintain a 3.0 GPA every semester by completing each class with a B grade or better.
3. Maintain good attendance, be punctual, participate in class, complete homework, and all other class requirements.
4. Attend each UBMS program meeting, class, and events during the school year and summer.
5. Complete all assigned activities and assignments thoughtfully and seriously.
6. Meet with my program and school advisor, counselor, mentors, and facilitators when scheduled.
7. Abide by UBMS and school attendance policies.
8. Take advantage of academic tutoring tools to comprehend class topics and to seek help before my grades are not meeting appropriate academic standards.
9. Work with and cooperate with all hired and volunteer staff working with UBMS.
10. Remain active in UBMS every summer and every semester through my high school graduation.
11. Plan and complete a post-secondary education program after high school graduation.
12. Stay in contact with UBMS after graduation to provide follow-up data about my path in obtaining a college degree.

UBMS staff may communicate with me, the student, and my parents/guardians, using the following tools,
- Facebook and other social media platforms
Text messaging and phone calls
- Email messaging and U.S. postal mail

ARIZONA BOARD OF REGENTS
FOR AND ON BEHALF OF
NORTHERN ARIZONA UNIVERSITY
Contracts, Purchasing and Risk Management

BEHAVIORAL EXPECTATIONS FOR NON-STUDENT MINORS

This NAU form outlines the behavior expected by NAU and Upward
Bound Math & Science of your minor while participating in our programs,
events, etc. Please be sure to emphasize thee expectations to your minor.

 

THIS DOCUMENT HAS LEGAL CONSEQUENCES. IT MUST BE COMPLETED AND SIGNED PRIOR TO PARTICIPATION. PLEASE READ IT CAREFULLY BEFORE SIGNING.

If not defined within the form, all capitalized words shall have the meaning as set forth in the Northern Arizona University Supervision of Non-Student Minors Policy.

Northern Arizona University is committed to providing a safe, enjoyable, and healthy learning environment for all NonStudent Minors involved in Programs on its campus to include virtual or on-line programs. Northern Arizona University encourages an environment of mutual respect. In order to promote the health and safety of all involved, participation by a Non-Student Minor may be terminated at the discretion of Program staff if the Non-Student Minor does not abide by these expectations.

Non-Student Minors are expected to follow all Northern Arizona University policies as well as the guidelines listed below:

1. Work cooperatively and respectfully with other Participants, volunteers, faculty, and staff.
2. Follow established Program rules and directions.
3. Use appropriate language and behavior at all times. Language or behavior that is abusive, harassing, or threatening may result in removal or suspension from the Program.
4. Use all Northern Arizona University property and materials appropriately. Charges may be incurred in the event of misuse or damage.
5. Dress appropriately for the activities as directed by Program staff, including the use of safety gear where required.
6. Remain on property where the Program is held or with the group at all times. Participants should not leave the property or group without prior notification and authorization from Program staff.
7. Obey all local, state, and federal laws.
8. Do not bring any prohibited items to Program activities and events, including for example tobacco, alcohol, drugs, illicit material, or weapons. Northern Arizona University’s campus and facilities are weapons and tobacco-free.
9. Do not host guests in Northern Arizona University-owned or provided overnight accommodations without express permission from Program staff.
10. Report to Program staff any abuse or neglect committed against any Non-Student Minor during the Program.

You must complete a personal essay as part of your application. Essays can be typed as a Word or Google Document and uploaded below: include your name, date, and your school year. You can SAVE and RETURN to this application at any time to UPLOAD your completed essay BEFORE SUBMITTING your application. Your essay should be appropriate in length while thoughtfully answering the prompts below:

1. Who are you, what makes you unique and special?
2. Describe your family, friends, and community. How do they mold who you are?
3. What do you hope to gain from joining the NAU UBMS program?
4. Why do you want to go to college? What are you doing now to work towards that goal?

 

Writing Style Tips
• Create an essay outline.
• Start with your introduction. Your opening sentences should capture the reader’s attention.
• The body paragraphs should answer the prompts supported with personal evidence from your life.
• Be specific and be descriptive. We want to meet the real you.
• End your essay with a conclusion. Share the lessons learned from the experiences shared.
• Proofread your essay by reading it out loud. Use correct grammar, spelling, capitalization, and punctuation.
• Have an English teacher proofread your essay.