TRiO Upward Bound Pre-Application Form

Last Name: 

First Name:    MI: 

Grade:  Select below: 9th 10th 11th 12th    Age:    Grade Point Average: 

What school do you attend: 

Mailing Address: 

City:  State:  ZIP Code: 

Email: 

Phone Number: --

Best time to call: 

Are you in Talent Search? Yes No

Are you committed to other activities? Yes No  Please specify: 

What are your plans after high school? 4-year college 2-year college Work

Has either of your parents completed a four-year college? Yes No

What is the number of family members? 

Career Choices:   

Do you receive: Free Lunch Reduced Lunch Neither

I understand that by submitting this form, I am giving New Mexico Junior College permission to obtain information from parents and/or school officials to determine if I will be invited to apply for admission to Upward Bound.