Upward Bound Math and Science Application

Directions

Please complete all items included in this application. Submission of a completed application does not guarantee acceptance into the program. If you are eligible, but not selected to be a participant or alternate, you will be placed on a waiting list. The Trio UBMS program provides participants with a six-week summer component with intense instruction and emphasis in math and science. During the academic year, students will attend college tours, cultural events, receive school visits, mentoring, tutoring, college/SAT fee waivers and much more.

A complete application must consist of the following documents:

Income verification
- U.S. Individual Income Tax Return (Form 1040, page 1 & 2), or
- UBMS Income Verification form (this form is only accepted if the family does not file taxes)
100 word essay answering the following questions:
- Why are you interested in math or science?
- What are your future goals?
- How can the Upward Bound Math & Science help you reach your goals?
Two(2) completed recommendation forms
- One completed by a guidance counselor and the second by a math or science teacher
A copy of your most recent report card/transcript (cumulative GPA must be reported)

PLEASE NOTE:
Completed applications and related documents are due by April 15.

Email: ubmsprogram@udel.edu

If you have any questions or concerns, please call us at 302-831-4994

Section 1: Student Information

Student Legal First Name

Preferred First Name

Student Middle Name (optional)

Student Last Name

Student Mailing Address

Country

Street

City

Region

Postal Code

Student Mobile Phone

Student Email Address

Oops! It looks like your Student Email Address and Preferred First Name are the same. Please review to ensure there's not an error.

Do you consent to receive text messages from the University of Delaware Office of Admissions?
This may include event reminders, event cancellations, location changes, deadline reminders, or updates about application and admission status.

Yes

No

Social Security Number*

*The Department of Education requires that we use Social Security information to identify our students. This information will be used only when necessary for administrative record keeping and program reporting. It is considered confidential, and will be handled as such. If you would prefer, you can provide your social security information to the UBMS program over the phone, by mail, or in person.

Student Birthdate

Place of Birth

Gender

Female

Male

What is your race/ethnicity? (If you are of a multi-racial/multi-ethnic/multi-cultural identity, mark all that apply)

Please specify

If accepted into the program, you will receive a program T-shirt. Please indicate your T- Shirt size should be be selected.

Section 2: Eligibility Information

This section is to be completed by a parent/legal guardian. The UBMS program is a federally funded TRIO program. We are required to determine whether our applicants are either the first in their family to graduate from a four-year college, or university, or that the family does not make an income that falls above the certain threshold. A signed copy of your current U.S. Individual Income Tax Return (form 1040, pages 1 and 2) or a signed income statement is required to verify income in order to determine your students eligibility for our program.

If you did not file an income tax return within the past year, please complete and submit the Income Statement form. Income tax returns can be emailed to ubmsprogram@udel.edu

Please select which income verification document will be submitted

A signed copy of U.S. Individual Income Tax Return Form 1040 (pages 1 and 2 only)

Income statement (only if parent/ guardian does not file Income Tax Return)

If you would like to upload a signed copy of U.S. Individual Income Tax Return Form 1040 (pages 1 and 2), you can do so here. Income tax returns can also be emailed to ubmsprogram@udel.edu.

US Citizen

Yes

No

Please upload a copy of your Green Card, Resident Alien or Permanent Resident Card.

Does you student receive free or reduced meals at school?

Yes

No

Do you receive any of the following (check all that apply)?

Temporary Assistance for Needy Families (TANF)

Supplemental Nutrition Assistance Program (SNAP)

Medicaid

Supplemental Security Income (SSI)

Social Security Disability Insurance Benefits

Does not receive any of the above

U.S. Department of Education Reporting Requirements

ADA Definitions of Qualified Disability
Under the ADA, an individual with a disability is a person who:
1. Has a physical or mental impairment that substantially limits one or more major life activities;
2. Has a record of such an impairments; or
3. Is regarded as having such impairment.

A physical impairment is defined by the ADA as: Any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.

A mental impairment is defined by the ADA as: Any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.

NOTE: The ADA does not list all conditions or diseases that make up physical, mental, and emotional impairments, because it would be impossible to provide a comprehensive list given the variety of possible impairments.

Are you a person with a disability as defined by the Americans with Disability Ace (42 U.S.C 12101 et seq.)?

Yes

No

Do you require accommodation based upon a physical/mental impairment (as defined by the ADA)?

Yes

No

If you require specialized accommodations based upon a disability, please bring this to the attention of the Program Manager who will work with the appropriate personnel to address individual needs. Disability documentation must be submitted for consideration of reasonable accommodation(s).

McKinney-Vento Homeless Assistance Act
SEC. 725. DEFINITIONS.
For purposes of this subtitle:
(2) The term homeless children and youths' means -

(A) Individuals who lack a fixed, regular, and adequate nighttime residence; and
(B) Includes -

(i) children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; are abandoned in hospitals; or are awaiting foster care placement;
(ii) children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings (within the meaning of section 103(a)(2)(C));
(iii) children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and
(iv) migratory children (as such term is defined in section 1309 of the Elementary and Secondary Education Act of 1965) who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses (i) through (iii).

At the time of the UBMS enrollment, were you homeless as defined by the McKinney-Vento Homeless Assistance Act?

Yes

No

Please Specify:

Involvement in the Juvenile Justice System

Juvenile delinquency cases. These cases involve minors who have committed crimes - meaning that if the crime had been committed by an adult, the matter would be tried in a criminal court.

Juvenile dependency cases. Cases involving minors who are abused or neglected by their parents or guardians - called "juvenile dependency" cases - are also heard in juvenile court. In a juvenile dependency case, the judge will ultimately decide whether or not the minor should be removed from the problematic home environment.

Cases involving status offenses. A status offense is violation that applies to minors. Examples include truancy (skipping school), ungovernability/incorrigibility, curfew violations, running away, and underage drinking.

At any time of the initial UBMS enrollment, were you (check all that apply):

Section 3: Parent Information

This section is to be completed by parent(s)/legal guardian(s)

Other:

Total number of people in the family household supported by family income?

Parent/Guardian #1

Parent/Guardian #1 Type

Parent/Guardian #1 First Name

Parent/Guardian #1 Last Name

Parent/Guardian #1 Preferred Phone Number

Parent/Guardian #1 Email Address

Parent/Guardian #1 Employer

Parent/Guardian #1 Home Address

Country

Street

City

Region

Postal Code

Did you receive a Bachelor's degree from a four-year college or university?

Yes

No

What is the name of the college?

Parent/Guardian #2

Parent/Guardian #2 Type

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Parent/Guardian #2 Preferred Phone Number

Parent/Guardian #2 Email Address

Parent/Guardian #2 Employer

Parent/Guardian #2 Home Address

Country

Street

City

Region

Postal Code

Did you receive a Bachelor's degree from a four-year college or university?

Yes

No

What is the name of the college?

Parent/Guardian Assessment

Your answers are kept confidential and are used to assess your child's need for help and potential. Upward Bound Math and Science is a program to help students with current issues as they prepare for adult/college life.

Why do you want your son/daughter to be in the Upward Bound Math-Science (UBMS) program?

Are you willing to support our goal of having your child pursue academic excellence with classes in high school and extra work with UBMS classes? How will you assist in ensuring your child studies and completes all assigned school and UBMS work?

How do you think your child could do better in school? What are some difficult subjects for her/him? What are the reasons why she/he is not always focused on academics?

What are some special qualities your son/daughter possesses?

What are some personal or motivational issues/problems for your child?

What chores and/or responsibilities does your child have around the house?

Being aware that UBMS is a seven-year commitment, are you willing to make the necessary arrangements for your child and your family to participate in all aspects of the program (i.e. transportation, homework time, communication with staff, planning family events around UBMS events, parent meetings) and assisting UBMS with tracking your child until they earn a four-year degree?

Yes

No

Section 4: Student Assessment

What school do you attend?

Current grade
You must be enrolled in grades 8 - 11 and at least 13 years of age to be eligible.

11th

10th

9th

8th

What is your shop?

Other:

Are you currently in a Trio program?

Yes

No

Please indicate which Trio program

Upward Bound Classic

Educational Talent Search

Transferring from another UBMS program

What extracurricular and/or volunteer activities are you participating in? (STEM clubs, work programs, athletics etc.)

What are your hobbies or special interests?

Please list three career choices in order of importance to you.

What do you plan to do upon graduation from high school?

What college would you like to attend?

Have you contacted your college of choice for information?

Yes

No

Do you know the process to enroll in the college of your choice?

Yes

No

Do you have information about financial aid programs?

Yes

No

Do you currently receive tutoring at your high school?

Yes

No

What subjects can UBMS assist you with?

Please explain in 100 words or more why you wish to become a participant in the University of Delaware Upward Bound Math & Science program.

Section 5: Recommender Information

Please provide us with the name and email address of your recommender. We will send that person a link to complete the recommendation form. Applications are not considered complete until both school counselor and a math/science teacher recommendations have been submitted to UBMS.

School Counselor

School Counselor First Name

School Counselor Last Name

School Counselor Email Address

Math or Science Teacher

Math/Science Teacher First Name

Math/Science Teacher Last Name

Math/Science Teacher Email Address

Section 5: Electronic Signature

PLEASE SIGN TO ACKNOWLEDGE THE FOLLOWING:

"I hereby certify that the information given by me in this application is true to the best of my knowledge. If accepted into the program, I agree to adhere to all rules and regulations specified by program staff."

Student Signature

Date

Parent/Legal Guardian #1 Signature

Date

Parent/Legal Guardian #2 Signature

Date