2021 Upward Bound Summer Program Application

  • 2021 Upward Bound Summer Program Application

    All fields of this application must be completed...
  • Image field 38
  • Gender:*
  • Format: (000) 000-0000.
  • I Plan to attend the 2021 Upward Bound Summer Program this summer:*
  • Format: (000) 000-0000.

  • STUDENT INFORMATION

  • Please select your (current) grade level:*
  • Please select your T-shirt size:*
  • Do you have any dietary restrictions? (i.e, don't eat meat):*
  • Enrollment Objective (Why are you interested in attending the summer program?):*
  • Enrollment Status:*
  • Please select the following areas of interest:*
  • Have you ever visited a college or university before?:*

  • COVID-19 INFORMATION

    Please provide accurate information.
  • Have you or anyone in your household tested positive for COVID-19 in the last 14 days?:*
  • Have you received the COVID-19 vaccination (And have proof)?*

  • APPLICANT AGREEMENT

  • I certify that the above stated information is true and correct to the best of my knowledge and that withholding or falsifying may make me ineligible for admission to the Upward Bound Summer Program.

    By submitting this form you release the Family Centered Educational Agency of any liability during the course of the summer program. You also agree that your son or daughter will abide by all the rules and regulations established by the program. Your signature also authorizes us to use any pictures/videos taken in connection with the activities of the virtual FCEA Upward Bound Summer Program to be used in publications (i.e., newsletters, television, website, presentations, magazine articles, etc.)

  • By entering your name in the box below, you are electronically providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.

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  • Date:*
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  • Should be Empty: