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Upward Bound Math/Science Participant Application

  1. COMPLETE STUDENT APPLICATION: Please read each question carefully and complete all sections. If you fail to answer all of the necessary questions, your application will be returned to you for completion. The information you provide on this form will be kept confidential.

    Deadline: 5 p.m., Friday, December 17, 2021

  2. COMPLETE PARENT AGREEMENT: Please make sure your parent completes the Parent Agreement and provides necessary documentation.
  3. THREE LETTERS OF RECOMMENDATIONS: You will need three letters of recommendation from a Math Teacher, Science Teacher, and your Counselor.
  4. INCOME ELIGIBILITY: Please submit a copy of last year’s signed tax return to ubms@nwmissouri.edu
  5. DISABILITY: Please send any documentation of a disability that has been verified by your doctor, or other professional to ubms@nwmissouri.edu. This would include a previous IEP (Individual Educational Plan) or 504 Plan, if applicable.
  6. TRANSCRIPTS: Your academic transcripts and records will be requested from your high school counselor, you do not need to provide them.
  7. INTERVIEW: You will be contacted after turning in your application to interview with an UBMS staff members.  The interview will last 15-20 minutes.
  8. QUESTIONS:  If you have questions about the application process, please call our office at 660.562.1538.

 


 

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* indicates required fields. If any information is unknown at this time, please enter N/A in the form field.

Step 1: Demographic Data

Applicant Information

*Applicant Name:












School Information



Demographic



*Applicant Gender:
*Ethnic Background:
*Are you a U.S. citizen?



Statement of Disability

*Do you have a physical, mental or documented learning disability which requires special accommodations to help you succeed academically?


Other

*Have you ever applied to an Upward Bound Math/Science Program before?
*Have you ever been a member of an Upward Bound Math/Science Program before?


Are you on social media? (check all that apply)

Step 2: Student Assessment

Student Goals


*Do you want to attend college?


Student Interests







Student Commitment

*Why do you want to join the Northwest Missouri State University Upward Bound Math/Science Program? (check all that apply)
*Are you able to participate in an academic program held on the Northwest campus approximately one Saturday morning each month?
*Are you able to participate in required mentoring held at your school? (may be held before or after school)
*Are you able to participate in a six-week residential summer program where you will be required to live on the Northwest campus? Residential Summer Component Dates: June 5 – July 17, 2022
Potential Summer Component Trip: July 11 – July 16, 2022


Personal Statement

Directions: Below or on a separate sheet(s) of paper, please address all of the following items in essay form in at least 100 words. Please type or print clearly.

1st Paragraph Introduce yourself and include information about your family and school.
2nd Paragraph Write about your background: where and how you were raised; any interesting incidences in your life.
3rd Paragraph Write about your plans for the future, including your college, career, and personal plans and goals.
4th Paragraph Discuss two of your academic strengths and academic weaknesses and two of your personal strengths and personal weaknesses.
5th Paragraph Explain why you want to become a part of the TRIO Upward Bound Math/Science Program and describe what role you see the Upward Bound Math/Science Program playing in your life and college/career plans.


Step 3: Agreement

I attest to the fact that the above information is true and accurate to the best of my knowledge.

I understand the purpose of the Northwest Missouri State University TRIO Upward Bound Math/Science Program, which is to prepare participants to successfully complete a program of postsecondary education. As part of my personal effort in this preparation, I commit to Upward Bound Math/Science and intend to participate in all academic year and summer components of the program. I understand that attendance is an integral part of participating. Therefore, I agree to attend and actively participate in all classes, meetings and activities sponsored by Upward Bound Math/Science. I will comply with all rules and regulations of the TRIO Upward Bound Math/Science Program, and I am aware that failure to comply could result in dismissal from the program.

*I understand and willingly commit to meeting these expectations.

By submitting this form, I certify that all the information I have typed into this form is correct and I understand that any false information (or omissions) in the contract agreement or its supporting documents will be sufficient grounds for my dismissal in the TRIO Upward Bound Math/Science program. I agree to all the above statements and will fully participate in the TRIO Upward Bound Math/Science program.

To retain a copy of this application for your records,
PLEASE PRINT THIS PAGE NOW!

 

    

 

Northwest Missouri State University
Upward Bound Math & Science
Administration Building 362 - West Wing
800 University Dr.
Maryville, MO 64468

Phone: 660.562.1538
Fax: 660.562.1631
Email: ubms@nwmissouri.edu