University Of Nevada-Reno-Washoe-UB-Application Form

Upward Bound

Hug & North Valleys High Schools
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About Upward Bound Classic & Math Science Programs

The Upward Bound Classic & Math Science (UB/UBMS) Programs of the University of Nevada, Reno provide 246 first-generation, income-qualified students with a comprehensive and enriching educational experience that prepares our students for success in life, college, and beyond. Our program is designed to equip students with the academic skills, leadership, professional development, critical thinking abilities, and personal qualities necessary to excel in higher education and thrive in their future careers.

Services Provided
- Advising and College Planning
- Academic Tutoring
- Literacy and Writing Support
- College Application and Scholarship Assistance
- ACT/SAT Preparation
- Financial Literacy Instruction
- Math and Science Instruction
- College Fairs and College Tours
- Career Internships
- Cultural Events, Leadership Development, Civic Engagement, and Other Activities
Please answer all questions in the below application; failure to do so will delay processing. If a question is not applicable, mark “N/A” in the space provided. The personal information, including financial status and educational levels, given to the UB/UBMS Programs is used for reporting purposes to determine if your child meets federal eligibility guidelines established by regulation of the United States Department of Education. All information is protected under the Family Educational Rights and Privacy Act (FERPA, 20 USC 1231a). No one may access, view, or utilize the information unless they work for or with UB/UBMS, or unless they are given specific or legal authorization to said information.
Student Information
Student Full Legal Name:*

First NameMiddle NameLast Name
Preferred Name:*
School ID Number (7 Digits):*
Gender:*

MF
Pronouns:*

He/HimShe/HerThey/ThemOther
Current Grade:*
Current School:*
High School: *
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:
(999)999-9999
Student Cell Phone Number:*
(999)999-9999
Student Email Address:*
example@example.com
Citizenship Status:*

U.S CitizenPermanent ResidentOther
Date of Birth:*

MonthDayYear
Date
Age:*
City/State of Birth:*
Ethnicity:*

AsianBlack/African AmericanHispanic/LatinoAmerican Indian/Alaska NativeNative Hawaiian/Other Pacific IslanderWhite/CaucasianMultiracialOther
How did you hear about UB/UBMS?*

Family and FriendsSocial MediaUpward Bound Visited My SchoolCounselor/Teacher(s)
List all co-curricular and other activities in which you are involved, both inside and outside of school. Examples include: Dean’s Future Scholars (DFS), Men of Color, work, athletics, band, student government, clubs, community or church groups, hobbies, or other organizations. If none, write "N/A".*
In 250-300 words, please explain why you are interested in participating in Upward Bound and how the program can help you achieve your college and career goals. When finished, please upload your response as PDF or Word document below. *

Cancelof
Counselor/Teacher Assessments

Please enter the name and email address for your Counselor, English Teacher, Math Teacher, and Science Teacher. The professionals you list below will be emailed an online assessment form to complete that will be added to your application.
Counselor Name: *
Email:*
example@example.com
Science Teacher Name:*
Email:*
example@example.com
Math Teacher Name:*
Email:*
example@example.com
English Teacher Name:*
Email:*
example@example.com
Parent/Legal Guardian 1 Information
Parent/Legal Guardian I Full Name:*

First NameLast Name
Parent/Legal Guardian I Relationship to Student:*
Parent/Legal Guardian I Preferred Language: *
Parent/Legal Guardian I Home Phone:
(999)999-9999
Parent/Legal Guardian I Mobile Phone:*
(999)999-9999
Parent/Legal Guardian I Email: *
example@example.com
Parent/Legal Guardian I Education completed:*

ElementaryHigh SchoolSome CollegeAssociate Degree (2-year degree)Bachelor’s Degree (4-year degree)Master’s or Doctorate Degree
Parent/Legal Guardian 2 Information (If Applicable)
Parent/Legal Guardian II Full Name:

First NameLast Name
Parent/Legal Guardian II Relationship to Student:
Parent/Legal Guardian II Preferred Language:
Parent/Legal Guardian II Home Phone:
(999)999-9999
Parent/Legal Guardian II Mobile Phone:
(999)999-9999
Parent/Legal Guardian II Email:
example@example.com
Parent/Legal Guardian II Education completed:

ElementaryHigh SchoolSome CollegeAssociate Degree (2-year degree)Bachelor’s Degree (4-year degree)Master’s or Doctorate Degree
Income Eligibility

A student may be eligible to participate in UB/UBMS if their family’s income meets the Federal TRIO Programs Current-Year Low-Income Levels.

The current income levels can be accessed at here: https://www2.ed.gov/about/offices/list/ope/trio/incomelevels.html
Did you/your family file taxes?*

YesNo
If Yes, Family’s household size (include student):
If Yes, Family’s taxable income (reference Line 15 on 1040 form):
If No, Family’s household size (include student):
If No, What is your family’s annual income:
By signing below, I certify that the household income information reported above is verified, true and accurate. I also understand that, if requested, I must provide documentation verifying my household income.
Parent/Legal Guardian 1 Printed Name:*
Parent/Legal Guardian 1 Signature:*

Clear
Date:*

MonthDayYear
Date
Certifications & Signatures

Student: I understand the purpose of UB/UBMS Programs is to prepare participants for successful completion of postsecondary education. As part of my personal effort in this preparation, and if accepted, I commit to UB/UBMS through the summer following my high school graduation, and intend to participate in all academic year and summer components of the programs. I will comply with all rules and regulations of UB/UBMS, and I am aware that failure to comply could result in dismissal from the programs.

Parent: I understand the purpose of UB/UBMS Programs is to prepare participants for successful completion of postsecondary education, and I would like to have my child participate in all activities, including field trips. I also authorize the employees of UB/UBMS Programs to have access to the student's academic records, to render medical aid if necessary, and I release UB/UBMS from responsibility for any harm incurred by the student.

By signing below, I certify that the information provided on the application is true and accurate to the best of my knowledge as indicated by my printed name and signature below. I also understand that any false statements or misrepresentation will make the applicant ineligible for UB/UBMS.
Student Printed Name:*
Student Signature:*

Clear
Date:*

MonthDayYear
Date
Parent/Legal Guardian 1 Printed Name:*
Parent/Legal Guardian 1 Signature: *

Clear
Date:*

MonthDayYear
Date
Parent/Legal Guardian 2 Printed Name:
Parent/Legal Guardian 2 Signature:

Clear
Parent/Guardian Printed Name:
Date:

MonthDayYear
Date

Upward Bound