Upward Bound Student Application

*The following responses will not affect your application status. Upward Bound needs to know how to best assist
you academically

I attest to the fact that the above information is true to the best of my knowledge. I understand UB’s purpose, which is to prepare students to successfully graduate with a bachelor's degree. I also know that the programs are all- year-round and once I am accepted, I will continue with the program until I graduate from high school. As part of my personal efforts in this preparation,I commit to UB through participation in all school year and summer program components. I understand that attendance is an integral part of participating. Therefore, I agree to attend and actively participate in all classes, meetings, workshops, college tours, and activities sponsored by UB. I will comply with all rules and regulations of the UB program at the University of Wisconsin-Milwaukee, and I am aware that failure to comply could result in dismissal from the program. I understand and willingly commit to meeting these expectations.

Father/Guardian

Mother/Guardian

Please enter all source(s) of total monthly household income below

If you do not receive WI ACCESS Services

I understand that this information is being given to receive federal funds, and any misrepresentation may make the applicant ineligible for participation. I certify that all the above income information is accurate and true and that all income
is reported.

Emergency Contacts - List two additional adults with whom the student is in contact.

I understand the purpose of the UB Program, which is to prepare participants to successfully complete a program of post-secondary education (college) and would like to have my child participate. Because parent involvement and support are major contributing factors to student success. I agree to be involved in the following ways:
1) keeping informed of my child's progress in school
2) encouraging my child to attend all UB activities
3) allowing my child to attend UB field trips
4) participating in UB events in which parents are invited
5) sharing concerns about my child's education with Program staff
6) supporting the UB staff in their efforts on behalf of my child.

I support the mission of Upward Bound and will make it a priority to assist my child in their education.

I hereby attest that all information in this application is true and correct. I also understand that a false statement or misrepresentation will make the applicant ineligible for the UB Program.

Dear Student, Parents, or Guardians:
We are asking your Parent or Guardian to sign a Release of Academic Information form allowing us access to your high school academic records for the purpose of proper placement. To fulfill U.S. Department of Education regulations for Upward Bound-Upward Bound Math & Science programs, we will need to track your academic progress for a period of six years after high school graduation.
Please read and sign this Release of Academic Information form. Your signature below
authorizes the University of Wisconsin - Milwaukee Upward Bound program to obtain
academic performance and enrollment data from the school(s) you are enrolled in at the time of our request.
Thank you for your assistance

If accepted as a participant of the University of Wisconsin - Milwaukee Upward Bound I hereby agree to the release of my academic records to the program. I have read and understand the terms of this request.

PLEASE READ THE FOLLOWING CAREFULLY. IF YOU HAVE ANY QUESTIONS
REGARDING THIS AGREEMENT OR WOULD LIKE TO NEGOTIATE ITS TERMS, CONTACT
UPWARD BOUND AT 414-739-5046

Assumption of Risks

You are being asked to sign this form because you would like to participate in the above-listed event Upward Bound (UB) sponsored by the University of Wisconsin – Milwaukee (“UWM”). Before you can participate, UWM asks that you read this document carefully. If you want to ask questions about this document or request changes to it, you can do so by contacting theparty listed above.
By participating in UB, you are putting yourself at some risk (e.g., accidents while traveling or harm from other people, etc.). The specific risks vary from one activity to another, but resulting injuries can range from minor (e.g., scratches and bruises), to major (e.g., fractures and internal injuries), or catastrophic (e.g., paralysis and death). UWM recommends you minimize your risks by talking to a doctor before participating in the UB Program and carrying insurance (insurance is not provided by UWM). Please sign here to indicate that you understand that risks are inherent in the Upward Bound program and you knowingly and willingly accept those risks.

Waiver of Rights
In exchange for allowing you to participate in the UB Program, UWM asks that you agree not to make a claim against UWM if you are injured while participating in the UB Program, even if your injury was caused by UWM’s negligence. This means you are giving up your right to sue UWM if you are injured during the UB Program.
“Injury” refers to injuries to both your body and your property, whether caused by a UWM employee or a third party. You are not being asked to give up your rights in the event UWM acts recklessly or in an intentionally destructive manner. Please sign here to confirm that you are willing to give up your claims and rights against UWM in the event you are injured (including the right to sue).