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DO YOU QUALIFY?
This program is federally funded, therfore certain criteria must be met. The following form is a PRELIMINARY screening for eligibility and will be used only by UPWARD BOUND staff. Please complete the following form and send it electronically to UPWARD BOUND. If you have any questions about UPWARD BOUND, call (715) 394-8085 for further information. Once we receive your interest form, we will contact you.
UPWARD BOUND - ELIGIBILITY APPLICATION
Student's Name
Parent\Guardian's Name
Foster Child	yesno
Address
Telephone
Birth Date
Age
Gender	malefemale

Ethnicity (optional)	CaucasianAfrican American Southeast AsianNative American HispanicOther
School
Grade
Year

Reported taxable income (after deductions) on the Federal Income Tax form or annual income not taxed (if Tax form not filed).
$13,965 and under$13,966-$18,735 $18,736-$23,505 $23,506-$28,275 $28,276-33,045 $33,046-$37,815 $37,816-$42,585 $42,586 and above
Size of Family including parents\guardians and yourself

Does the parent(s) living with you have a college degree?	Mother YesNo
	Father YesNo
Are you a U.S. Citizen?	YesNo
If not, are you a permanent resident of the U.S.?	YesNo