Upward Bound Application

Race

American Indian or Alaskan Native

White or Caucasian

Native Hawaiian or Other Pacific Islander

Black or African American

Asian

Other

Citizenship Status *

US Citizen

Legal Permanent Resident

Other

Current grade *

Name of the high school you will be attending after 8th grade? *

High school attending *

Richwood High School

Peoria High School

Manual Academy

Does your parent/guardian have a bachelor's degree *

Yes

Does the student and parent/guardian share address information *

Yes

Source(s) of income *

Does your parent/guardian have a bachelor's degree

Yes

Does the student and parent/guardian share address information

Yes

Does this parent/guardian share address information with the previous parent/guardian above

Yes

Source(s) of Income *

Does the student qualify for free/reduced lunch and textbooks at school *

Yes

Please note

If you would like a copy of your application, please make sure you include an email within the student contact information.

I certify that the information in this application is complete and accurate to the best of my knowledge. I understand that submission of false or misleading information can result in disqualification from the program.

Illinois Central College

Student Contact Information

Student Demographics

Student High School Information

Parent/Guardian Information

Additional Parent/Guardian Information

Household Information

Signatures