Please enter Student information:
First Name *
Middle Name
Last Name *
Preferred Name
Date of Birth *
Sex *
Preferred Gender Pronouns *
What is your race? (Optional)
Report another race, if applicable. (Optional)
Hispanic/Latino Ethnicity (Optional)
What is your citizenship status? *
If other, please enter here:
Do you have a physical disability? *
What is your current family status? *
Address 1 *
City *
State *
Zip Code *
Student Phone Number *
Student Email Address *
How would you like to be contacted? *
How did you hear about Upward Bound? *
If referred by a current UB member, please provide his/her name:

Please enter Parent/Guardian information:

You will need a parent/guardian to help you complete this section.
Parent/Guardian #1 Name *
Parent/Guardian #1 Address 1 *
Parent/Guardian #1 City
Parent/Guardian #1 State *
Parent/Guardian #1 Zip Code
Parent/Guardian #1 Phone number
Parent/Guardian #1 Email Address
Parent/Guardian #1 Employer
Parent/Guardian #1 Relationship *
Did parent/guardian #1 graduate with a four-year degree from a college or university? *
If yes, which college or university?
Parent/Guardian #2 Name
Parent/Guardian #2 Address 1
Parent/Guardian #2 City
Parent/Guardian #2 State
Parent/Guardian #2 Zip Code
Parent/Guardian #2 Phone Number
Parent/guardian #2 Email Address
Parent/Guardian #2 Employer
Parent/Guardian #2 Relationship
Did parent/guardian #2 graduate with a four-year degree from a college or university?
If yes, which college or university?
Student Academic Information:
Current High School Attending *
High School Graduation Year *
What school did you attend for Middle School? *
Have you attended any other high school/s? If so, please list here.
Are you taking any college prep, honors, or AP courses this academic year?
Do you currently participate in another college prep program, such as VSAC? *
If yes, what is the name of the program?
Teacher Recommendation #1 - Math, Science, or English Teacher ONLY - Name of teacher *
Math, Science, or English Teacher eMail *
Teacher Recommendation #2 - Any teacher or school counselor - Name of teacher or counselor *
Any teacher or school counselor eMail Address *

Household Information:

You will need a parent/guardian and federal tax information (2023 IRS 1040) to complete this section.
Which of these choices apply to you or your household? *
How many in your household? *
What was your household Adjusted Gross Income, line 11 on the 1040 tax form? *
What was your household Taxable Income, Line 15 on the 1040 tax form? *
2023 IRS 1040 Document Upload - this upload is secured by StudentAccess and Castleton University.
If your income has recently changed, please describe the circumstance.

Authorization for Release of Information:

By signing below, I authorize Castleton University Upward Bound to receive copies of my student's transcripts, grade reports, test scores, and other materials necessary for application review and, if accepted, for the duration of his/her secondary and post-secondary education.
Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Statement of Agreement:

By signing below, I certify that to the best of my knowledge, the information given is correct.  I understand that misrepresentation of facts on this application will be cause for refusal of admission, cancellation of admission, or suspension from Upward Bound.  By signing, I also agree to abide by the policies and regulations of the Castleton University Upward Bound program.
Student Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Today's Date *