ORS Pre College Program Application

Please rate yourself in each of the following categories.

5 = Above Average, 4 = Average, 3 = Below Average, 2 = Needs Help, 1 = No Experience
GRAMMAR*
SPELLING*
WRITING MECHANICS*
COMPOSITION & ESSAYS*
RESEARCH PAPERS*
LIBRARY & RESEARCH METHODS*
GENERAL READING & ANALYSIS*
STUDY SKILLS*
LISTENING & NOTE-TAKING*
ANNOTATION & NOTE-TAKING*
TEST-TAKING SKILLS*
GEOMETRY*
ALGEBRA I*
ALGEBRA II*
PRECALCULUS - CALCULUS*
BIOLOGY*
PHYSICS*
CHEMISTRY*

Before we can finish processing your application, we need to verify your family’s taxable income. The Department of Education requires us to review taxable income levels to make a decision about enrolling your student into the Upward Bound/UBMS Program.

Please complete the following statement regarding total taxable income for the household in which your student currently resides.

Taxable Income Instructions – Taxable income is often different than actual wages, and can be found on your tax return document (1040) or a Tax Return Transcript. You can retrieve your Tax Return Transcript for free at: https://www.irs.gov/individuals/get-transcript.
For the previous year, as reported on your tax return, please provide the total NUMBER OF PEOPLE living in your household.*
For the previous year, as reported on your tax return, please provide the DOLLAR AMOUNT OF YOUR ANNUAL TAXABLE household income.*
Parent/Guardian Signature: By signing this form I verify that the above income and household size information is correct to the best of my knowledge. *

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I understand that as part of the Opportunity Resource Services Upward Bound/UBMS Program selection process, the applicant’s school records including transcripts, test scores, and academic progress reports will be examined.

I also understand that if the applicant is selected for the Upward Bound/UBMS Program, the Program will continue to require this information from any high school and college the applicant may attend. This information is necessary to track the performance of the programs’ participants and graduates.

I, the undersigned parent or legal guardian, hereby give permission to Opportunity Resource Services Upward Bound and Upward Bound Math and Science Program to request the information listed on this form from the applicant’s high school and any future colleges that he/she may attend.

I, the undersigned student, hereby give permission to Opportunity Resource Services Upward Bound and Upward Bound Math and Science Program to request the information listed on this form from any high school and any future colleges that I may attend.

1) All school records, including, but not limited to, grade reports and attendance records

2) Transcripts/Standardized test scores

3) Information from faculty/staff on the student’s status and performance in the classroom

4) Student’s contact information
Student's Full Name*

First NameLast Name
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

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Student Signature*

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