Upward Bound Summer Residential Staff Application
Personal Information
Last Name
First Name
Middle Initial
Preferred Name
College/University
Standing
Please Select
Freshman
Sophomore
Junior
Senior
Graduate
Alumni
Permanent (Home)Address
Address
Street Address Line 2
City State
State / Province
Zip
Current Address
Address
Street Address Line 2
City State
State / Province
Zip
Email Address
example@example.com
Phone
Driving Information
Do you have a current drivers license?
Please Select
Yes
No
Do you have any points on your license?
Please Select
Yes
No
Are you comfortable driving a 10-passenger van?
Please Select
Yes
No
Academic Information
Please select the academic subjects with which you would be comfortable assisting students.
Algebra 1
Geometry
Algebra 2
Trig/Pre-Calc
Calculus
Prob and Stat
Biology
Chemistry
Physics
Environmental
Literature
Writing
Grammar
Spanish
French
Career Exploration
College Planning
SAT/ACT Prep
Study Skills
Life Skills
References
Name
Relationship
Phone
Email
example@example.com
Name
Relationship
Phone
Email
example@example.com
Name
Relationship
Phone
Email
example@example.com
How did you hear about Upward Bound?
Please Select
Career Fair
Flyer
Instructor/Professor
Email
Career Services
Friend/Classmate
Other
Additional Questions
Since this is a residential program, what adjustments may high school students need to make when living in a residence hall?
Upward Bound prepares students to enter college What are some topics/areas that students may need assistance with?
Upward Bound works with underserved students How can you make an impact on our students?
Describe at least two activities you would be comfortable planning and leading These could be for a small group (6-10 students) or a large group (25-40 students).
Describe your experience working with or supervising students of any kind or age.
Why are you interested in working with Upward Bound?
Additional Documents
Please attach your resume, letter of interest, and unofficial transcripts.
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