READMISSION APPLICATION

OAKLAND UNIVERSITY

PROJECT UPWARD BOUND
READMISSION APPLICATION

(Please print clearly or type)
STUDENT INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number:
Cell Phone Number
Your Email Address:*
example@example.com
High School Name:*
Grade Level:*
Your Counselor's Name:
Current Cum GPA:
Expected Date of High School Graduation:*
Current Extra-Curricular Involvements (Clubs, Teams, etc.):*
Please list any medical conditions that have arisen since you were last enrolled that may affect your PUB participation or performance:*
PARENT & EMERGENCY CONTACT INFORMATION
Parent First Name:*
Parent Last Name:*
Parent Contact Phone #1:*
Parent Contact Phone #2 :
Parent Place of Work (Business Name):
Parent Place of Work (City located in):
Work Phone Number
Parent Email Address:*
example@example.com
Name of Alternate Emergency Contact:
Relationship to Student:
Phone Number:
Reason for Leaving PUB:*
Reasons why you wish to return to PUB:*
PLEDGE OF COMMITMENT

By signing below, I commit to follow the listed requirements:

1.         I agree to attend College Club at least 2 hours per week and to use PUB’s one-on-one tutoring if my GPA has fallen below 3.00 since leaving PUB.

2.         I agree to attend every scheduled Saturday Academy in part or in whole. If I miss a virtual sessions(s), I agree to watch the recorded version and submit whatever assignments are due within a week of the original recorded date.

3.         I agree to attend the applicable Summer Academy (graduating seniors excepted).

4.         I agree to honor all other rules, regulations, and requirements as put forth in the PUB handbooks and other Project literature or by the Project administrators.

I understand that if I break this commitment, I am automatically choosing to forfeit my PUB membership with no further opportunity for readmission.
E-Signature:*

Clear
Today's Date:*

MonthDayYear

OAKLAND UNIVERSITY

READMISSION APPLICATION

STUDENT INFORMATION

PARENT & EMERGENCY CONTACT INFORMATION

FOR OFFICE USE ONLY: