Upward Bound at UW-L Student Application

Please complete this form and submit it. Once we receive it we will contact you for the School and Parent parts of the application. Remember, your Student application is not complete until you have mailed or emailed us your Personal Statement - four or five paragraphs telling a little about yourself.

If you have any questions, please call us at 608 785-8539.

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State
Zip
Home Phone
E-mail
Date of Birth
Gender	Female Male
Citizenship:
If non-citizen, enter Alien Registration Number.	A
Birthplace
Ethnicity	First, are you Hispanic/Latino/Latina? yes no
Ethnicity
	Check as many as apply by holding down "Control" key as you choose.

School

Other:

Grade in school:

Language(s) spoken in home

Chinese
English
French
German
Hmong
Vietnamese
Other

If other, what language(s):

With whom do you live?

Name(s) of person(s) checked above:

Address and Phone if different than yours

Street Address

Address (cont.)

City

State

Zip

Home Phone

E-mail

In school I get mostly:

Extra-curricular activities (in school and out):

Spare time interests:

Plans after high school?

Do you want to go to college?

Yes
No
Not sure

Why/Why Not?

Please let us know how you heard about the Upward Bound program: UB staff visited my school School counselor Newspaper article

Other:

To complete your Student application to Upward Bound at UW-La Crosse, please email us a four or five paragraph Personal Statement telling a little about who you are, what you like and don't like and what your plans for the future are. If you have any questions, please call us at 608 785-8539.

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