Upward Bound Summer Academy 2022

* fields are required

The Summer Academy offers students an exciting and engaging program of academic instruction, career, college and personal development activities. Meals, instructional supplies, bus tickets and other items will be provided. All services and activities are FREE for the students and families whom we serve.

Registration will take place until Thursday, March 31, 2022.
Parents/Students are asked to complete the bottom section of this registration form. Return your completed registration form to the Upward Bound office. If you plan to participate in Y.O.U. the deadline for Summer registration is March 4, 2022.

Attend the Summer Academy Orientation on Saturday, June 11, 2022. More information about the orientation will be sent out as the date approaches. Students are required to attend this orientation before the summer program.

Students, please encourage your parent or guardian to attend orientation with you.

Student First Name: *

Student Last Name: *

Street Address: *

City: *

Zip Code: *

Home Phone: *

Student's Current High School: *

Student Email: *

In the Fall of 2022, I will be in the: *

T-shirt Size: *

Parent/Guardian 1: *

Parent/Guardian 1 Phone: *

Parent/Guardian 1 Address: *

Parent/Guardian 1 City: *

Parent/Guardian 1 State: *

Parent/Guardian 1 Zip: *

Parent/Guardian 2:

Parent/Guardian 2 Phone:

Parent/Guardian 2 Address:

Parent/Guardian 2 City:

Parent/Guardian 2 State:

Parent/Guardian 2 Zip:

Parent Email: *

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