UNHTRIOUBLogoAbbreviated

UNH Upward Bound
Student Eligibility & Application Form
Nesmith Hall, 131 Main Street • Durham, NH 03824
Office: 603-862-1563      Fax: 603-862-3270
www.upwardbound.unh.edu

Thank you so much for your interest in the UNH Upward Bound program! We are a federally funded college preparatory program that provides services at no cost to 114 students attending Farmington, Somersworth, Spaulding, Manchester Central, Memorial, West, and School of Technology High Schools. Our mission is to help students develop the skills necessary to successfully graduate from high school and go on to college in order to earn a two or four-year degree within six-years of high school graduation. Since 1966, UNH Upward Bound has helped several thousand New Hampshire young people earn college degrees and improve their options for successful careers. Our program begins during the Academic Year and continues through the Summer Residential Academy.

Application Process
A completed application requires:

  • Student Application (this form). We strongly encourage you to complete the online application using a computer (rather than a mobile device or tablet).
  • Records Release and Advising Permission Forms (included in this form)
  • Teacher Recommendation (Requested in this form)

Once we have received your completed materials, we will review your application. If you are selected for an interview, an Upward Bound staff member will contact you to set up an appointment. Interviews last about thirty minutes. Admission into the program is based on financial and academic eligibility, academic need, readiness for program services and available space. In addition, Upward Bound students must be either US citizens, permanent residents or applying for permanent residency. All answers are treated confidentially.

If you have any questions, don’t hesitate to call me at (603) 862-3859. You can learn more by visiting our website, www.upwardbound.unh.edu, our Facebook page at facebook.com/unhupwardbound, or our Instagram feed at instagram.com/unh_upward_bound/.

Sincerely,
Joshua A. Gagnon
Director, UNH Upward Bound

Section 1:
General Student Information
Student's Legal First Name: *
Middle Initial
Last Name *
Preferred Name
Preferred Pronoun(s)
Gender *


Mailing Address & Contact Information
Street Address or PO Box *
City/Town *
Local State *
Zipcode *
Home Phone
Student Cell Phone *
Email *
Primary Language(s) Spoken at Home? *
If Other, What Languages are Spoken at Home?


Race & Ethnicity
Choose "1" if you identify "YES" or choose "2" for "NO"
Hispanic/Latino *
Asian *
White *
American Indian/Alaskan Native *
Black or African American *
Native Hawaiian or Other Pacific Islander *

Section 2:
Student's Educational Information
Current High School *
If Other, What HS Do You Attend?
Current Grade in School (ex. 9th)? *
Expected Year of HS Graduation? *
Name of School Counselor? *

Have you in the past, or are you currently, a participant in any of the following programs?
UNH UB (Previous Applicant) *
UNH Educational Talent Search *
GEAR UP NH *
Breakthrough Manchester *
Breakthrough SNHU *
Other TRIO (UB, ETS) Programs *

Section 3:
Student's Eligibility Data
Date of Birth (MM/DD/YYYY) *
Age *
Social Security Number *
Citizenship *

Please Note: Applicants who are not US Citizens will need to provide a current copy of their Permanent Resident and/or Arrival-Departure records ONCE they are accepted into the program.
If you were not born in the US
Where were you born?
When did you move to the US?

Section 4:
Family Eligibility Data
With whom does the student primarily live during the school year? *

Please note:

  • Applicants who indicate they have Legal Guardians or Foster Parents will need to provide custodial documentation upon acceptance into the program.
  • Homeless students will need to provide McKinney-Vento certification upon acceptance into the program.

The following questions relate to Parent(s)/Guardian(s) with whom the student primarily lives: 
Parent/Guardian 1 Full Name *
P/G 1 Relationship to Student *
P/G 1 Phone (Cell Preferred) *
P/G 1 Email
P/G 1 Occupation
P/G 1 Highest Education Level *
Parent/Guardian 2 Full Name
Contact 2 Relationship
Contact 2 Cell Phone
P/G 2 Email
P/G 2 Occupation
P/G 2 Highest Education Level

Additional Persons Living in the Primary Residence
In the spaces below, please provide the names, ages, and the relationship to the student (sister, brother, Aunt, grandparent, etc.) of any additional people living in your primary residence (do not include yourself or the P/Gs listed above).

Example: Joshua Gagnon (Brother, 19)
Full Name (Relationship to Student, Age)

Parent/Guardian Income Verification
The following questions pertain to household income based on the parent(s)/guardian(s) listed above. 

  • Please use your most recent Federal Tax Return information (not older than 2 years) to answer the following questions.
  • Students who are in foster care, are a ward of the state, or who are homeless under the McKinney-Vento Homeless Assistance Act, may write N/A in the two boxes below.

Please enter Total Taxable Income in the box below (line 15 on Tax Form 1040).
Total Taxable Income *

In the box below, please enter the number of people in your household that depend on this income.
Number of People in Household *
  • Final acceptance of this application may require you to submit copies of pages 1 & 2 of your tax returns for verification.  
  • If you are not required to file taxes, you may be asked to supply copies of your end of year SSI statement, unemployment check-stub, recent TANF or SNAP statements, or W-2s from all income sources for verification.
  • You may be asked to supply a personal statement explaining your unique financial situation.

Section 5:
Teacher Recommendations

Please list below the names of two core subject teachers (English/ESL, Math, Science, Social Studies or Foreign Language) who we may contact to provide recommendations. 

 
Teacher 1 Full Name *
Teacher 1 Email *
Teacher 1 Subject Taught *
 
Teacher 2 Full Name *
Teacher 2 Email *
Teacher 2 Subject Taught *

Section 6:
Student College & Career Questions
and Personal Statement
Please check the services below that you believe will be helpful to you this year:
Academic Tutoring
Career Exploration
College Exploration & Entry
College Exam Prep (SATs/ACTs/TOEFLs)
Academic Course Selection Advice & Assistance
Info. About Financial Aid and Scholarships
Managing Stress & Anxiety
Study Skills/Time Management
UB Summer Academy
Upon graduation from high school, what do you think you would like to do (Check all that you are considering)
Attend a trade school (for example, auto repair)
Attend a 2-year community college
Attend a 4-year college or university
Get a job
Enlist in the Military

Please complete the following two prompts thoughtfully and thoroughly, as it is an important part of your application:

1. Reflecting on the services you selected above, in what ways (academic, social, college/career guidance, etc.) can Upward Bound be most helpful to you?

You may choose to upload your statement (recommended) or write it in the space below
Upload Your "How Can UB Help You" Statement (Preferred):
How Can UB Help You Statement (300 Words or Less):

2. We believe that every student has a background, interest, or talent that is so meaningful that their application would be incomplete without discussing it. Please share your story.

You may choose to upload your statement (recommended) or write it in the space below
Upload Your "Personal Story" Statement (Preferred):
Personal Story Statement (300 Words or Less):

Section 7: Upward Bound Application Certification & Program Commitment

By signing below, I certify that:

I hereby apply for admission to the Upward Bound program at the University of New Hampshire and agree to abide by its rules and guidelines. I understand that should I be accepted, I will remain in the program throughout my high school years, I will enter into a two or four-year college program in the fall immediately following high school graduation, and I will strive to complete a two or four- year program within six years. I also will be expected to undertake a rigorous, college-bound, high school curriculum and work towards earning grades of B or better in all my courses.

Furthermore, I understand that all new students are placed on a 60-day probationary period when they first begin participating in UNH Upward Bound. Throughout the probationary period, I will be evaluated on adherence to the UNH Upward Bound Guidelines and AY Agreement. Failure to successfully meet the requirements of the probationary period will result in non-admittance to the program. Successful completion of the probationary period will allow me to be in good standing with the program and participate fully in all programmatic events including regular UB Advising, tutoring & mentoring opportunities, Saturday Academies, college & cultural trips, and our Summer Academy.
Student Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
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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
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Signature: (Type in your full name)
I agree to the terms included.