Upward Bound Program
University of Hawai‘i at Hilo
STUDENT APPLICATION
It i
s essential that the entire application be completed before it is returned to Upward Bound. Type or print clearly (in black
ink) and do not hesitate to add information you feel is important.
LAST Name: ______________________ FIRST Name: ______________________ MI:__________ Female Male
Mail
ing Address: __________________________________ City: _________________ State: __________Zip: __________
Home Address: __________________________________ City: _________________ State: __________Zip: __________
Home Phone: (______)-_______-_______ Cell Phone: (______)-_______-_______ Alternate: (______)-_______-_______
Email Address: ______________________________________________________________________________________
High School: ___________________________________________ Grade: 8
th
9
th
10
th
11
th
12
th
(currently attending or will attend in the fall semester)
Place of Birth: City: ____________________ State: ___________ US citizen Permanent Resident
(If you are not a US citizen, please attach a copy of your alien registration card [front & back])
1. How long have you lived in the U.S.? ____ (years) ____ (months)
2. Ethnicity (check all that apply): Hispanic Hawaiian Asian White
American Indian/Alaskan Pacific Islander
African American
other: ______________
3. Wha
t language is spoken most often at home? English If other language, please identify ________________
4. Do you currently participate in any of these programs? Tal
ent Search Gear Up AVID
5. What are your post high school educational plans? 2-year College 4-year College
6. Do you have an IEP? Yes No If yes, you must include a copy of your IEP with your application packet.
7. Why
do you want to participate in Upward Bound?
8. What kind of career would you like to have when you become an adult? ________________________________________
Why this career? ____________________________________________________________________________________
9. What are the obstacles which may prevent you from going to college? Check all that apply.
Low GPA Predominantly Low Income Community Rural Isolation
Low Achievement Test Scores Lack knowledge of Financial Aid process Unstable Family Life
Low Educational Aspirations Interest in career in Math & Science Poor Study Habits
Grades need improvement Diagnosed Learning Disability
Lack of Motivation Limited English Proficiency
Lack of Opportunity Extra-Curricular Activities, Clubs
Lack of Career Goals Lack of knowledge of process to apply
Lack of Confidence Don’t know what I want to do with my life
11/20/18
