upward bound student application - Yuba College
upward bound student application - Yuba College upward bound student application - Yuba College
Upward Bound Yuba College2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858UPWARD BOUND STUDENT APPLICATIONYuba CollegeName________________First Name Last Name MiddleStreetAddress City Zip____________Home phone____________________________Cell PhoneMailing Address (if different)______________E-mail address ____________________________________Social Security #___________________________________City_____________________________ Zip____________Ethnicity Sex: Male FemaleSchool Counselor Grade___________BirthdatePlease fill in the spaces below for all the members of your household. (Include yourself)Name Relationship Age Grade* School________________________________________________________________________*or highest grade/year in school/college completed. Please attach another piece of paper if necessary.What languages are spoken in your home? ________________________________________________________________Have you or any of your siblings been enrolled in an Upward Bound Program? YesNoIf yes, who, and at what college/university?Are you or any of your siblings in another outreach program such as ETS, MESA, or AVID?Yes No If yes, who?Which program(s)?Do you have a job? Yes No If you have a job, where?PositionDays and times you work
Upward Bound Yuba College2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858Please answer the following questions as honestly and specifically as possible. Attach another page if necessary.What do you think is the function of the UPWARD BOUND Program? _________________________________How do you expect the Upward Bound PROGRAM to help you? ______________________________________What do you feel you can contribute to UPWARD BOUND?_________________________________________What do you think will be expected of you as an UPWARD BOUND student? _____________________________________________________________________________________________________________________________________________________________________________________________________________________What school subjects are your strongest? Why?__________________________________________________________________________________________________________________________________________With which subjects do you have difficulties? Why? ___________________________________________________________________________________________________________________________________________Are you willing to meet with the Upward Bound Specialist at your school?Yes No Not sureAre you willing to participate in after-school tutorials at your school? Yes No Not sureAre you willing to participate in the Upward Bound Saturday Academies at your school?Yes No Not sureAre you willing to participate in the Upward Bound Saturday Enrichment Activities?Yes No Not sureAre you willing to participate in a 6-Week Summer Academic Program at Yuba College?Yes No Not sure
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Upward Bound <strong>Yuba</strong> <strong>College</strong>2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858UPWARD BOUND STUDENT APPLICATION<strong>Yuba</strong> <strong>College</strong>Name________________First Name Last Name MiddleStreetAddress City Zip____________Home phone____________________________Cell PhoneMailing Address (if different)______________E-mail address ____________________________________Social Security #___________________________________City_____________________________ Zip____________Ethnicity Sex: Male FemaleSchool Counselor Grade___________BirthdatePlease fill in the spaces below for all the members of your household. (Include yourself)Name Relationship Age Grade* School________________________________________________________________________*or highest grade/year in school/college completed. Please attach another piece of paper if necessary.What languages are spoken in your home? ________________________________________________________________Have you or any of your siblings been enrolled in an Upward Bound Program? YesNoIf yes, who, and at what college/university?Are you or any of your siblings in another outreach program such as ETS, MESA, or AVID?Yes No If yes, who?Which program(s)?Do you have a job? Yes No If you have a job, where?PositionDays and times you work
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