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Upward Bound

University of Wisconsin-Superior

Erlanson Hall 14
Belknap and Catlin
P.O. Box 2000
Superior, WI 54880

ph. 715-394-8219

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Eligibility Application

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Eligibility Application

This program is federally funded, therfore certain criteria must be met. The following form is a PRELIMINARY screening for eligibility and will be used only by UPWARD BOUND staff. Please complete the following form and send it electronically to UPWARD BOUND. If you have any questions about UPWARD BOUND, call (715) 394-8085 for further information. Once we receive your interest form, we will contact you.

Student's Name:

Your Email Address:

Parent\Guardian's Name:

Foster Child:

Yes

Address:

Telephone:

Birth Date:

mm/dd/yy

Age:

Gender:

Male

Female

School:

Grade:

Year:

School Counselor:

Reported taxable income (after deductions) on the Federal Income Tax form or annual income not taxed (if Tax form not filed).:

$16245 and under

$16246-$21855

$21856-$27465

$27466-$33075

$33076-$38685

$38686-$44295

$44296-$49905

$49906-$55515

$55516 and above

Size of Family including parents\guardians and yourself:

Does the parent(s) living with you have a college degree? Mother:

Yes

Father:

Yes

Are you a U.S. Citizen?:

Yes

If not, are you a permanent resident of the U.S.?:

Yes

How did you hear about our Program?:

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University of Wisconsin-Superior is an equal opportunity educator and employer

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