Name:    

Permanent Address (someone who will know where you are for the next few years):


Which High School:

Currently: College:

Other:

Major:

Expected Year of Graduation:

Currently out of college?: yes no
If so where did you attend?:

Until when?:

Why did you leave?:

Did you Graduate?: yes no
If so with what degree?:

If not do you plan on going back?: yes no
If so when?:

Currently: Are you working?:

In what position?:

Anything else you would like to tell us about? Family? Travel? Future Plans?

How did your participation in Upward Bound help you?

Do you have any advice to current students?

Would you like to be involved in the program in some way? yes no

I would like information on how to...

Apply to be a tutor counselor
Apply to be a faculty member
Apply to be a year round staff member
Volunteer to be a tutor
Help in the office during school breaks
Offer an elective in the summer program
Help with fundraising events
Host students at my college
Be available to talk to students about my college or career
Come to Summer Career Day to talk about my career
Come to Alumni Day to talk about my college experience
Make a contribution to the program
Write letters to legislators to advocate for the program

Other

Would you like to receive email notices from the program? yes no

May we share your information with others who may be interested in finding you or hearing more about your experience? yes no