Sandburg TRIO Upward Bound Application

Carl Sandburg College TRIO Upward Bound Interest Form
The Carl Sandburg College TRIO Upward Bound Program thanks you for your interest. Please complete the form in its entirety and insure that all provided information is accurate.

In addition to the online interest form, you will need to complete and submit the complete application. The full application can be downloaded from the Upward Bound website and should be submitted to:

TRIO Upward Bound, Carl Sandburg College, 2400 Tom L. Wilson Blvd., Galesburg, IL 61401

Should you have any questions about the application process or the program in general, please contact us at 341.5268 or sgross@sandburg.edu. Thank you.

Please note this online form is only for those applying to Upward Bound, for those interested in Upward Bound Math-Science, please visit their website.

THE APPLICATION PERIOD FOR 2019 CLOSES ON APRIL 19, 2019.
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail Address
example@example.com (please do not use a school affiliated email)
Birth Date

MonthDayYear
Gender
U.S. Citizen
Current School
Current Grade
Need for Program Services
With Whom Do You Live?
Mother's Name
Mother's Phone

Area CodePhone Number
Father's Name
Father's Phone

Area CodePhone Number
Guardian's Name
Guardian's Phone

Area CodePhone Number
Siblings
Please list all siblings, their age and current grade level.
Academic Courses
Please list all current classes and the grade received in each on the most recent report card.
Educational Plans
Please select your educational intentions for after high school.
College Choices
Please list two colleges that you are currently interested in.
Career Choices
Please list two careers that you are currently interested in.
Ethnicity
Ethnicity Con't.
If chose "More Than One", please specify.
Mother's Education
Please select the mother's highest level of education completed.
Father's Education
Please select the father's highest level of education completed.
Guardian's Education
Please select the guardian's highest level of education completed.
How Many People Live in Your Household?
Include any children away at school.
2018 Taxable Income
Please select the range in which the family's 2018 taxable income falls in.
I hereby certify that the information provided, to the best of my knowledge, within this application is complete, current, and accurate.
Student Initials
Parent Initials
Date

MonthDayYear
Please enter the text to the right in the box.
Full Name

First NameMiddle NameLast Name
Disclaimer:

Carl Sandburg College hosts two (2) TRIO Upward Bound Programs. One (1) UB program is known as "Classic Upward Bound" while the other UB program is known as "Upward Bound Math & Science". These are two (2) distinct and separate programs. The interest you completed above is for the "Classic Upward Bound" Program. Should a student be interested in Upward Bound Math & Science, they would need to visit the UBMS website @ www.sandburg.edu/UBMS for further information. *Please note, students are only allowed to participate in one (1) TRIO Upward Bound Program.
Should be Empty:

Carl Sandburg College TRIO Upward Bound Interest Form

I hereby certify that the information provided, to the best of my knowledge, within this application is complete, current, and accurate.

Disclaimer: