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Upward Bound Participant Application

  1. COMPLETE:  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, November 13, 2020
  2. INCOME ELIGIBITY:  Tax information will be collected on the Parent portion of your application for review.
  3. ADDITIONAL FORMS:  Please print the two documents shown below (your school counselor can print them for you). You will need to provide your school counselor with the School Counselor Recommendation form View PDF, and you must request that a teacher whose class you have been in the previous or current school year fill out the Teacher Recommendation form View PDF. These forms are due in the Upward Bound office by 5 p.m., Friday, November 13, 2020.
  4. INTERVIEW:  Once your eligibility has been determined, applicants will interview with Upward Bound Central Staff. Interviews usually take place in November.
  5. QUESTIONS:  If you have questions about the application process, please call our office at 660.562.1630.

Do NOT refresh the page or risk losing your progress.

* 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?

(please provide a copy of your Premanent Resident Card with your application)


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

Statement of Disability

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


Step 2: Student Assessment

Student Goals


*Do you plan to attend college?
*Do you want to attend college?


Student Interests







Student Commitment

*Why do you want to join the Northwest Missouri State University Upward Bound 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 6 – July 9, 2021
Potential Summer Component Trip: July 12 – July 16, 2021


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 Program and describe what role you see the Upward Bound program playing in your life and college/career plans.


Essay Prompt

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

The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?


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 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 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. I will comply with all rules and regulations of the TRIO Upward Bound 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. I agree to all the above statements and will fully participate in the TRIO Upward Bound program.

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

 

    

 

Northwest Missouri State University
TRIO Upward Bound Office
Administration Building 372 - West Wing
800 University Dr.
Maryville, MO 64468

Phone: 660.562.1630
Fax: 660.562.1631
Email: UB.NWMSU@gmail.com