The Ohio State ATI

UPWARD BOUND

Program

Yes, I am college-bound and interested in Upward Bound.  If I appear eligible, please send me a complete application packet.

NOTE: THIS PROGRAM IS ONLY FOR STUDENTS RESIDING IN THE CANTON, ORRVILLE, and WOOSTER AREAS.

Student's Name:

Student's Street Address:

City    Zip code

Phone:

Student attends, or plans to attend

Student's Age:

Student's Grade Average 

 A     B    C    D     F

Current Grade Level:                              Citizenship Status:

 8     9    10    11                      U. S. citizen     Other    

Student lives with:

Father's name:

Mother's name: 

Guardian's name:

Does the student's mother or father have a Bachelor's degree?    Yes    No

Student's Career Goal: 

Date:

 

 

 

 

 

 

 

         ________________

Signature of Student                                          Date

 

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