• University Of Nebraska-Lincoln

    UB-Application Form

  • Dear Applicant,

    Thank you for your interest in the UNL Upward Bound Math Science Program. This application serves as the initial step in joining our program, which aims to empower high school students like you to achieve their academic and personal goals. By completing this form, you are taking the first exciting step towards unlocking opportunities for personal growth, academic enrichment, and college readiness.

    Please ensure that you provide accurate and complete information in all the fields provided. Once we receive your application, our team will begin processing it. You can expect to hear from us soon after submission to discuss the next steps in the application process. 

    If you have any questions or need help while completing the application, please feel free to contact our office at (402) 472-8887. Our staff are here to support you throughout this journey.

    We commend you for taking this important step toward your future success, and we look forward to the possibility of welcoming you into the UNL Upward Bound Math Science family.

    Sincerely,

    UNL Upward Bound Program

    • Student Information: 
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    • Parent Information: 

    • 21. Emergency Contact Information: If we are unable to contact you in the case of an emergency, who would you like us to contact?

    • Parental Permission, Certification and Verification to be completed by the Parents(s) or Legal Guardian(s) 

    • Please understand that the Upward Bound Math/Science administrative staff respects the confidentiality of each applicant and his/her family. Considerable care is observed to assure that personal and family information is not publically accessible, Understanding the Upward Bound Math/Science commitment, do you:

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    • Release Information: Initialing in this section gives the parent/guardian consent for the following releases/consents.

    • STUDENT AND PARENT SIGNATURE AND APPROVAL

      I (We) understand that Upward Bound Math/Science will use data provided on this form to assist in assessing any academic and/or career planning needs for the student. I (We) understand all the information will be used in strict confidence. I (We) certify that all information provided is correct to the best of my (our) knowledge.

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    • I further certify that all the information on this form is valid and correct. A copy of my income tax return 1040, Medicaid card and/or income verification are/is attached.

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    • Family Financial Statement

      One of the criteria for admissions in the Upward Bound Math/Science Program is meeting the income guidelines established by the U.S. Department of Education. Before we can determine your son or daughter's eligibility, we need the following information. Please read carefully and complete all blanks. All income information is considered confidential and maintained only in the Upward Bound Math/Science office.

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    • FREE/ REDUCED LUNCH ELIGIBILITY

    • Student and Parent Signature and Approval 

    • I (We) understand that the Upward Bound Program Math/Science will use the data provided on this form to assist in assessing any academic and/or career planning needs and that all of the information will be used in the strictest of confidence. I certify that all information provided is correct to the best of my knowledge. 

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    • Authorization Form: Student Participation and Release of Information 

    • I hereby give permission for my child, {main_name}, to participate in both the school year and the summer portion of the Upward Bound Math/Science Program. I will encourage him/her to particpate in all of the activities of the program. I understand that the program cannot be held responible for all occurrences during either the school year or summer portion of the program I understand that I am still responsible for my son's/daughter's conduct and the consequences of his/her behavior while in the program.

      I authroize the Lincoln Public Schools to release from my son's daughter's records to University of Nebraska-Lincoln's Upward Bound Math/Science Program during the entire duration of his/her high school career.

      In the event that my child's participation in the Upward Bound Math/Science Program be terminated for any reason during his/her high school enrollment, the Lincoln Public Schools will retrain authorization to release information from his/her records to the University of Nebraska-Lincoln's Upward Bound Math/Science Program.

      I authorize the Lincoln Public Schools administrative staff and teachers to share information regarding my son's/daughter's progress with the University of Nebraska-Lincoln's Upward Bound Math/Science Program staff.

      I authorize the Lincoln Public Schools administrative staff and teachers to share information regarding my son's/daughter's progress with the University of Nebraska-Lincoln's Upward Bound Math/Science Program staff.

      I authrozie the Upward Bound Math/Science Program to share appropriate information with the Lincoln Public Schools.

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    • Submit 
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