Itasca Upward Bound Application
Please complete the following application with your name, contact information, and a little bit about your academic history. Once we receive this completed form, an Upward Bound staff person will contact you within 1-3 days with more details about the program and next steps for joining!
First Name *
Middle Name
Last Name *
Date of Birth *
Gender
Address 1 (Permanent) *
Address 2 (Mailing)
City *
State *
Zip *
Home Phone (Landline)
Parent/Guardian Name(s)
Parent/Guardian Cell Phone Number
Parent/Guardian Email
Student Email Address
Student Cell Phone Number
Race/Ethnicity
Are you a U.S. Citizen?
Academic Info:
Current Grade Level *
Current School Attending
What is your current Grade Point Average (GPA)?
Do you have an IEP or receive any Special Education services?
What are you most likely to do after high school graduation?
Family Information:
Has your biological/adoptive mother earned a Bachelor's degree from a four-year college?
Has your biological/adoptive father earned a Bachelor's Degree from a four-year college?
How many people in your household?
Family Income Range
Most Recent IRS 1040 (Optional)
What is the best way to reach your parent/guardian?
What is the best time of day to reach your parent/guardian?
Sign and Submit:
Applicant Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number: