Thank you for your interest in joining the Northern Vermont University - Lyndon Upward Bound Program! Please fill out the following application to the best of your ability and with the most accurate and up to date information. Once your application has been fully submitted, along with your transcript, report card, recommendation letters, and personal statement, we will begin the review process! 

Applicant's Demographics:
First Name *
Middle Name
Last Name *
DOB *
Social Security Number *
Gender Assigned at Birth *
Preferred Gender / Pronouns
Home Phone Number *
Student Cell Phone Number *
Student Email *
Address 1 *
Address 2
City *
State *
Zip *
Applicant Lives With *
If you selected 'other' above, please explain
Other Household Members (brothers, sisters, etc.) *
Citizenship Status *

Ethnicity:

Please check all that apply.

White
Hispanic
Black/African American
Asian
American Indian/Native Alaskan
Native Hawaiian/Other Pacific Islander

Educational Information:
School You Currently Attend *
Current Grade Level *
Anticipated Graduation Date *
Name of Guidance Counselor *
Your Educational Honors (briefly describe any scholastic distinctions or honors you have received) *
How did you hear of UB? *
Are you a VSAC Talent Search or GEAR UP student? *

Parent Information:
Name of Mother (or Guardian) *
Address (if different from applicant) *
Occupation *
Place of Employment *
Work Phone Number *
Email *
Level of Education Completed *

Name of Father (or Guardian) *
Address (if different from applicant) *
Occupation *
Place of Employment *
Work Phone Number *
Email *
Level of Education Completed *

Family Financial Information:

To be eligible for the Upward Bound Program a student must meet the eligibility guidelines established by the United States Department of Education. We need the following information to determine eligibility. This information will be kept confidential.

On your most recent Federal Income Tax form, what was your taxable income? *
How did you file on your Federal Forms? *
How many exemptions do you claim (line 6d)? *
Is the student a Ward of the State? *
Do you receive income from any of the following agencies? Check all that apply.
Social Security
Disability
Aid for Dependent Children
Veteran's Benefit
General Assistance
Other
Please upload a signed copy of your most recent Federal Income Tax Form. *

Personal Statement:

Please attach a one page essay answering the following: What are your reasons for wanting to be in Upward Bound? What do you want to do after completing High School?

Personal Statement *
Student's Name (printed) *
Student's Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
Date of Signature *

Transcript Release:

I hereby give permission to have the Guidance Office send a copy of my transcript, report cards and test scores to the Upward Bound Program at Northern Vermont University. The files at Upward Bound are only open to the students and his/her parents. No information is released from the Upward Bound files without student's and/or parent's permission. 

Student's Name (printed) *
Student's Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Date of Signature *

Recommendations:
Counselor Recommendation: We require that students submit a letter of recommendation from their guidance counselor to this application. This letter should detail whether the counselor feels that the applicant has the potential for success in a formal, post-secondary educational institution. In addition, the counselor should supply a copy of the applicant's transcript and most recent report card. Student's must send their counselor an e-mail asking for this recommendation and provide the following link. If they already have this recommendation they can also upload the file below. https://nvul-ub-pub.studentaccess.com/appform/default.aspx?guid=970cb94c-bfb6-40e4-8dd9-f230e113c4c1
Name of Counselor *
Counselor's Email *
Counselor's Phone Number *
Official Counselor Recommendation

Teacher Recommendation: We require that students submit a letter of recommendation from their math, science, or English teacher along with this application. This letter should detail whether the teacher believes that the applicant has the potential for success in a formal, post-secondary educational institution and how the applicant compares to their peers. Student's must send their teacher a e-mail asking for this recommendation and provide the following link. If they already have this recommendation they can also upload the file below. https://nvul-ub-pub.studentaccess.com/appform/default.aspx?guid=b2e3d7fc-a1ee-4384-a300-b59b8c0a024a

Teacher's Name *
What class does this teacher teach? *