Upward Bound Interest Form



Upward Bound Interest Form Centralia College Upward Bound is a supportive community that prepares high school students who have limited access to higher education opportunities by assisting students in gaining the knowledge, skills, and resolve required to graduate from high school, and enroll in and graduate from college.
Welcome/instructions: If you are interested in joining the Centralia College Upward Bound program, complete this short interest form. Make sure to include at least one type of parent/guardian contact information (phone number or email). Upward Bound staff will contact you within one week of receiving this form.
Statement of confidentiality/funding: The information you provide in this application is confidential according to the Family Education Rights and Privacy Act. The U.S. Department of Education has the authority to gather the information requested in this application (20 USC 1231a). The only persons authorized to examine the contents of this application are the student, their parents, employees at the school attended, and authorized Upward Bound staff. The Centralia College Upward Bound TRIO project is 100% federally funded at $309,505 annually.
Contact Information:
First Name *
Last Name *
Current High School *
Current Grade Level * 8 9 10 11
Student's Personal (non-school) Email Address *
Student Phone Number (Cell phone if available)
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Relationship Mother Father Other
Parent/Guardian Email Address
Parent/Guardian Cell Phone Number
Parent/Guardian Home Phone Number
Preferred Language for Application * English Spanish

Upward Bound

Interest Form

Centralia College Upward Bound is a supportive community that prepares high school students who have limited access to higher education opportunities by assisting students in gaining the knowledge, skills, and resolve required to graduate from high school, and enroll in and graduate from college.

Welcome/instructions:

If you are interested in joining the Centralia College Upward Bound program, complete this short interest form.

Make sure to include at least one type of parent/guardian contact information (phone number or email).

Upward Bound staff will contact you within one week of receiving this form.

Statement of confidentiality/funding:

The information you provide in this application is confidential according to the Family Education Rights and Privacy Act. The U.S. Department of Education has the authority to gather the information requested in this application (20 USC 1231a). The only persons authorized to examine the contents of this application are the student, their parents, employees at the school attended, and authorized Upward Bound staff.

The Centralia College Upward Bound TRIO project is 100% federally funded at $309,505 annually.

Contact Information:

First Name *

Last Name *

Current High School *

Current Grade Level *

Student's Personal (non-school) Email Address *

Student Phone Number (Cell phone if available)

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Relationship

Parent/Guardian Email Address

Parent/Guardian Cell Phone Number

Parent/Guardian Home Phone Number

Preferred Language for Application *