Summer Residential Application Form

Upward Bound Frostburg State University 101 Braddock Road Frostburg, MD 21532
In addition to this application form, you will need to submit a letter of interest and qualifications, a resume, and an unofficial transcript.
Which position are you applying for?*

Tutor/CounselorHead Resident
Name (First, MI, Last)*
DOB*

MonthDayYear
Date
Cell Phone Number*
Please enter a valid phone number.
Permanent Address*
Permanent City, St, Zip*
College Address*
College City, St. Zip*
College email address*
example@example.com
Personal email address*
example@example.com
Which email do you prefer we use to communicate with you?*

College Email AddressPersonal Email Address
College currently attending*
What is your current college standing?*

FreshmanSophomoreJuniorSeniorCollege Graduate
Do you have a valid drivers license?*

YesNo
Do you have any points on your driving record?*

YesNo
If yes, how many points?
Which of the following subject areas (at the high school level) do you feel you have a strong ability to assist students?*

Algebra IAlgebra IIGeometryTrigonometryCalculusBiologyChemistryEnvironmental SciencePhysicsEnglish (Literature)English (Writing)English (Grammar)SpanishFrenchChinese (Mandarin)
Please list any hobbies and interests that you have that you would like to share with our students:*
How did you hear about the Upward Bound Program at Frostburg State University?*

AlumniCareer ServicesInternetInstructor/ClassFriendNewspaperOther
Please list the name, relationship, phone number, and email address of three professional references:
Reference #1
Name*
Relationship (supervisor, instructor, mentor, etc.)*
Phone Number*
Email Address*
example@example.com
Reference #2
Name*
Relationship (supervisor, instructor, mentor, etc.)*
Phone Number*
Email Address*
example@example.com
Reference #3
Name*
Relationship (supervisor, instructor, mentor, etc.)*
Phone Number*
Email Address*
example@example.com
1. What adjustment problems may high school students have living in a residence hall?*
2. What assistance may high school students need while preparing for college?*
3. How can you make a difference?*
4. What can you tell us about yourself that could help us evaluate you for this position?*
Attach your letter of interest, resume, and copy of your unofficial transcripts.

Cancelof
Should be Empty:

In addition to this application form, you will need to submit a letter of interest and qualifications, a resume, and an unofficial transcript.

Reference #1

Reference #2

Reference #3