Phillip And Patricia Frost Museum Of Science-UBMS-Application Form

Phillip And Patricia Frost Museum Of Science-UBMS-Application Form

Upward Bound Math and Science Program Application
- Full Legal Name: *
  
  First NameLast Name
- Preferred Name:
  
  First NameLast Name
- Date of Birth:
  
  MonthDayYear
  Date
- MaleFemaleNonbinaryPrefer not to answer
- American Indian/Alaska NativeAsianBlack or African AmericanHispanic/LatinoNative Hawaiian/Other Pacific IslanderWhiteOther
- Mailing Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Home Phone:
  (999)999-9999
- Cell Phone:
  (999)999-9999
- Student Email*
  example@example.com
- MDCPS School ID Number
- Zoned High School:
- Current High School:
- 9101112
- Expected High School Graduation Date:
  
  MonthDayYear
  Date
- Current GPA (unweighted):
- Math & Science courses completed:
- Extracurriculars/Clubs :
- To be considered for UBMS, at least one must apply:
  ☐ Neither parent/guardian has a bachelor’s degree (First Generation)
  ☐ Family meets federal low-income guidelines (Student receives free/reduced lunch)
- No HSSome HSHS DiplomaSome CollegeAssociateBachelor’sGraduate
- No HSSome HSHS DiplomaSome CollegeAssociateBachelor’sGraduate
- # in Household:
- YesNo
- If yes, please describe support services used:
- Parent/Guardian Name(s):
- Relationship to Student:
- Address (if different):
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Primary Phone:
  (999)999-9999
- Email:
  example@example.com
- Preferred Language:
- 1. Why are you interested in participating in the UBMS program?
- 2. What are your academic and career goals (especially in math, science, or technology)?
- 3. Describe any challenges you face in school that you hope UBMS can help with.
- 4. Is there anything you would like our staff to know about you that wasn't already asked?
- Most recent report card or transcript
  
  Cancelof
- Copy of most recent standardized test scores (if available)
  
  Cancelof
- Proof of family income (eligibility letter for free/reduced lunch)
  
  Cancelof
- Disability documentation (if applicable)
  
  Cancelof
- Parent/Guardian Consent:
  I certify that the information provided is accurate to the best of my knowledge. I give
  permission for my student to apply to the UBMS program, and authorize the release of school records (grades, transcripts, test scores, enrollment, and graduation status) for program participation and federal reporting purposes.
- Parent/Guardian Signature:
  
  Clear
- Date:
  
  MonthDayYear
  Date
- Student Agreement:
  I agree to participate fully in the UBMS program, including Saturday Academy, summer program, academic support, and STEM enrichment activities.
- Student Signature:
  
  Clear
- Date
  
  MonthDayYear
  Date

Please verify that you are human*
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