Upward Bound Online Application

Upward Bound is a college access program designed to assist high school students who would like to put in the time and effort to be college ready to enter the college of their choice by fall after high school graduation.

To complete this application, you will be required to upload the following document:

  • A copy of federal tax filing, or a letter explaining why your family did not have to file

We interview all applicants and their parents. Once you have completed the application process, we will call you to set up an interview. Thank you for applying to Upward Bound!

The information you provide in this application is confidential according to the Family Rights and Privacy Act. The US Department of Education has the authority to gather the information requested in this application (20 USC 1231a). The only persons authorized to examine the contents of this application are the student, their parents, employees at the school attended, and authorized Educational Talent Search staff. 

Student Information
First Name *
Middle Name *
Last Name *
Address *
Address 2
City *
State *
Zip *
Student's Home Phone
Student's Cell Number
Student's Email *
Are you a citizen of the United States? *
If no, please provide your permanent resident ID#:
Date of Birth: *
Social Security Number:
Language(s) spoken at home: *
Gender *

Academic Information

Current School *
Current Grade Level: *

Cultural Background Information

Ethnic (Hispanic) 1 ='Yes' 2='No' *
Please select your ethnicity *

Family Information and Eligibility

The federal government requires that we collect information and documents in order for students to participate in Upward Bound. Please include a copy of the two first pages of your federal tax forms or a letter explaining why you do not have to file. 


Student Lives With *
Parent or Guardians Education Level *
Do you qualify for free or reduced lunches? *
Number of people in the household *

*For Annual taxable income, please use the income of the parent the student lives with 51% of the year. If the answer is zero, type "0". If possible please include a copy of last year's tax return. If you do not file taxes please type "Do Not File".

Please do not use Gross Income or Adjusted Gross Income. Only use NET TAXABLE INCOME. This is the amount of the adjusted gross income minus you child tax credits per dependent child you claim.

Net-Taxable Income (Unemployment, VA Benefits, Retirement, Food Stamps, Disability)
If the applicant is a ward of the count please provide the Caseworker Name and Number:

Guardian Information

Please fill out the following information for the legal parent(s) or guardian(s) of the student.

Parent or Guardian 1

Full Name *
Relationship *
Student lives with me *
Phone Number
Email Address *
Occupation *
Work Phone

Parent or Guardian 2

Full Name
Student lives with me
Phone Number
Email Address
Work Phone

Media Release Form

Do you give permission your son/daughter to be interviewed, photographed, or videotaped by Educational Talent Search for use on radio, TV, in printed news media, or in program promotional materials and documentations?

Media Release Permission *
Most recent IRS 1040 or Tax Exempt Documention *
Why do you want to join Upward Bound?
What does your life look like six years after graduation?
What type of career are you most interested in and why? 

Student and Parent Contract

In order for us to serve you with a strong academic, cultural and collegiate program, we must have a sincere commitment from you. Please carefully review the following:

I understand that during my participation in Upward Bound:

  1. My goal will be to complete high school and pursue post-secondary education.
  2. I will aim to have at least a 3.0 GPA during my high school years.
  3. I will accept appointments and attend all meetings arranged by my Upward Bound Coordinator. 
  4. I will participate in all required Upward Bound meetings and Saturday Seminars. 
  5. I will attend the six-week summer academy. 
  6. I will abide by all rules and regulations of Upward Bound and Umpqua Community College. 
  7. Poor attendance or lack of participation will be a basis for dismissal from Upward Bound.
  8. I will be drug free, and if I am under the influence of any drugs (including alcohol) during an Upward Bound activity, I will be immediately dismissed from the program and not allowed to re-enter or re-apply at any time.

In addition to the application data given here, UCC Upward Bound will need to obtain information from other sources to sufficiently meet the academic needs of UB students and the reporting requirements of the US Department of Education. We gather information from high schools, colleges, testing institutions, and other agencies or universities on behalf of the UB students and program. Your signature at the bottom of this application authorizes Upward Bound to:

  1. Request a copy of your middle, high school, and college transcript. 
  2. Request for standardized state test scores from your school and/or the district. 
  3. Request a copy of your SAT and/or ACT test scores.
  4. Use your Social Security number to request a copy of your financial aid application, transcripts, college enrollment status, and awards from the federal and state funding agencies, post-secondary institutions, and the National Student Clearinghouse.
  5. Communicate with representatives from agencies or post-secondary institutions on your behalf.

I hereby authorize Upward Bound to contact and request information from, as well as share information with, the above-mentioned parties. I give my son/daughter permission to participate in Upward Bound activities if accepted. Our signatures below indicate our commitment to the Upward Bound Student and Parent Contract. 

Your signatures below will testify to the accuracy of all information provided and submitted through this application.

Please wait a few moments for the signature pad to appear after clicking E-Signature.
Fill out one signature box at a time. 

Parent Signature: *
Please select a signature verification type.
Student Signature: *
Please select a signature verification type.