University of Delaware Upward Bound Classic APPLY BELOW Upward Bound Classic Application Our Mission is to promote each young scholar's learning experience by providing a series of specialized college preparatory services including: tutoring, mentoring, advising, programming, and on-campus experiences to increase low-income first generation student persistence and graduation from high school, and a realistic chance to enter and graduate from a College or University. Application Directions Please ensure that all fields of this application are filled out. Completed applications do not promise that a student will be selected for the program. Eligible students who are not selected will be placed on our waitlist and notified when a space opens. If prefered, paper Applications are available for download and can be sent to the following address: Upward Bound Classic 12 West Delaware Avenue Newark, DE 19716 FAX: 302-831-6684 Please call our office with any questions or concerns 302-831-6667 Date Student Information arrowup6 To be completed by the student. Student First Name * Student Last Name * Middle Initial T-Shirt Size * Home Address (Number & Street) * City * State * Zip * Email Address Home Phone Student Cell Checkboxes * I will require a DART bus pass I will NOT require a DART bus pass What is your status as a citizen of the United States? * I am a US Citizen I am not a Citizen I have a Green Card Social Security # (no dashes) * Student Social Security # Social Security numbers are used as confirmation of Citizen Status. This information will be used only when necessary for administrative record keeping and program reporting. It is considered confidential, and will be handled as such. Please provide your social security information to the Upward Bound program over the phone, by mail, or in person. Birthdate * Gender Identification * Male Female OtherOther Ethnicity * White (non-hispanic) Hispanic/Latino Native Hawaiian/Other Pacific Islander Black/African America Asian American Indian/Alaskan Native Other Health Information Please list any health or learning issues we should know about Extracurricular Activities * What extracurricular activities are you participating in? (Clubs, Athletics, Work, Church, JROTC, etc) Hobbies * What do you enjoy doing in your free time? What do you plan to do upon graduation from high school? * Attend a 4-year college (Bachelors Deggre) Attend a 2-year college (Associates Degree) Attend a Trade School Join the Armed Services Get a Job Undecided Please list three career choices in order of importance to you * Please explain in 75 words or more why you wish to become a participant in the Udel Upward Bound Classic Program * School Information arrowup6 To be completed by the student Current School * Current Grade * 8th grade 9th grade 10th grade If you are a current High School Junior or Senior, you do not meet the requirements to apply Expected Graduation Year * Current GPA for 9th and 10th graders (refer to your most recent report card) * If you are a current 8th grader, which high school are you planning on attending next year upon acceptance? Course of Study * College Prep, Vo-Tech, Honors, or A.P. School Counselor's Name * Counselor's Phone Number * Counselor's Email Address * Parent/Guardian Information arrowup6 To be completed by the parent or legal guardian With whom does the applicant live? * Both Parents Father Mother Guardian If you selected guardian, please specify if guardian is related to you. (i.e. grandparent, aunt, uncle...ect) Father/Guardian's Name Mother/Guardian's Name Father/Guardian's Address (if different than yours) Mother/Guardian's Address (if different than yours) Father/Guardian's Phone Number Mother/Guardian's Phone Number Father/Guardian's Employer Mother/Guardian's Employer Father/Guardian's Work Phone Number Mother/Guardian's Work Phone Number Father/Guardian's Email Address Mother/Guardian's Email Address Eligibility Information arrowup6 The Upward Bound Classic program is a Federally Funded TRIO educational program. We are required to determine whether our applicants meet the criteria of first-generation and/or low-income status prior to their acceptance into the program. Has either of your parents received a bachleors degree from a (4) four-year College or University? * Yes, my father has received his bachelors degree Yes, my mother has received her bachelors degree Yes, BOTH of my parents have received a bachelor degree No, neither my mother or my father received their bachelors degree If yes, at which higher education institute did they receive their degree(s) from? Do you receive and of the following (check all that apply) * Public Assistance Social Security Foster Child Support AFDC No, Not Applicable 2022 Tax Information Drop a file here or click to upload Choose File Maximum file size: 52.43MB Please upload a copy of your U.S. Individual Tax Return (Form 1040, Pages 1 & 2) to verify your income status. If you do not file an Income tax return, we must received either a signed document from the student's parent regarding family income or verification of family income from another government source (i.e. Social Security statement or signed statement from caseworker). If you prefer to mail or fax your tax return you may send it to our office 12 W. Delaware Avenue Newark, DE 19716 (302) 831-6684 *The application is not considered complete until this information has been received. Student Social Security Number Information * Drop a file here or click to upload .doc, .pdf, .jpeg Choose File Maximum file size: 52.43MB Please upload a picture, pdf, or Word document with your student's valid social security number. Students must have a valid Social Security number in order to receive their federal funds such as stipends, participation in college tours ect. All documents are secured and destroyed once the application is printed for review. Only the Program Coordinator will receive this document. *The application is not considered complete until this information has been received. I understand that without a valid social security number I can not be accepted into the program. You may email the number securely to Ms. Nafatari Manigault, Academic Program Coordinator at nafatari@udel.edu or leave a voice mail with her at 302-831-6667. She confirm with you upon reciept of social security number. * Signatures arrowup6 "By submitting my electronic signature below, I hereby certify that the information given by me in this application is true to the best of my knowledge. If accepted into the program, I agree to adhere to all rules and regulations specified by the program's staff." Student Signature * Date Parent/Guardian Signature * Date If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Δ
