Thank you for your interest in Upward Bound-TRIO at UW-Superior! Upward Bound is a FREE federally-funded program that helps students in Superior, WI prepare to be the first in their families to earn a college degree.  

If you have any questions about the form or the program, please contact us at 218-206-6615 or ub@uwsuper.edu, or visit our website: www.uwsuper.edu/ub for more information.  After we receive this form and determine your eligibility, we will meet with the student at Superior Middle School for a short interview. 

Student Information
First Name (Legal) *
Last Name (Legal) *
Preferred Name *
Pronouns *
Gender *
Current Grade Level *
8th Graders: What is your advisory teacher's name? *
How did you hear about our program? *
School Lunch Number *
Non-School Email
Phone Number *
Date of Birth *
Primary Address *
Are you a US citizen or permanent resident of the US? *
Race(s): (Native American, Asian, Black or African American, Hispanic or Latine, White or Caucasian, Pacific Islander, etc.) *

Parent/Guardian 1 Information

This information should refer to the adult with whom the student lives/the student's primary caregiver.
Parent/Guardian 1 First & Last Name *
Parent/Guardian 1 Relationship to Student *
How often does the student live with this caregiver? *
Is Parent/Guardian 1 the Student's legal guardian? *
Parent/Guardian 1 Occupation *
Parent/Guardian 1 Employer *
Parent/Guardian 1 Highest Level of Education COMPLETED *
Parent/Guardian 1 Address *
Parent/Guardian 1 Phone Number *
Parent/Guardian 1 Email Address *

Parent/Guardian 2 Information

This information should refer to the adult with whom the student lives/the student's primary caregiver.
Student Does Not Have a 2nd Parent/Guardian
Parent/Guardian 2 First & Last Name
Parent/Guardian 2 Relationship to Student
How often does the student live with this caregiver?
Is Parent/Guardian 2 the Student's legal guardian?
Parent/Guardian 2 Occupation
Parent/Guardian 2 Employer
Parent/Guardian 2 Highest Level of Education COMPLETED
Parent/Guardian 2 Address
Parent/Guardian 2 Phone Number
Parent/Guardian 2 Email Address

Family Information
Family Taxable Income Range *
How many people are in your household? *

Student Writing Sample

Students: Please answer the following questions using 4-6 sentences each. 
Describe yourself as a student. Is school important to you? Do you go to school every day? What motivates you to do well? *
Discuss the challenges that you face at home or school. How do you overcome these challenges? How have they changed you, or what have you learned? *
Consider your future: what dreams and goals do you have for yourself? Describe why and what you will do achieve them.

Guidelines for Upward Bound Students
  1. Students must attend the six-week summer residency on the UWS campus their first summer in the Program.
  2. Students are expected to attend weekly Thursday Study Nights and Monthly Saturday academies. If a student is unable to attend, they must contact Upward Bound staff in advance.
  3. Students must maintain a GPA of 2.3 or higher.
  4. Students are expected to complete high school courses that will prepare them for college.
  5. Special activities offered by the Upward Bound Program are privileges. Failure to meet the guidelines and expectations of the Upward Bound Program may result in exclusion from these activities.
  6. Students are expected to behave in a way that reflects the Upward Bound Program's values of Accountability, Growth, Inclusion, Balance, Courage, and Flexibility.
I have read the above guidelines and agree to follow the expectations of the Upward Bound program. *

Authorization for Release of Information

Superior School District has my permission to release educational data (including transcripts, grades, standardized test scores, attendance records) to the Upward Bound Program at the University of Wisconsin-Superior. I understand that Upward Bound will use the educational data for the following reasons:

  1. To determine eligibility for and admission into the program.
  2. Upward Bound must track students’ academic progress to remain in compliance with federal grant guidelines and demonstrate program effectiveness to the U.S. Department of Education. Participant test scores and grades are used in Upward Bound’s Annual Performance Report.
  3. To connect Upward Bound students to scholarship agencies, youth leadership, employment, educational, and other programs.

I understand that this release is valid from the date of signature through the end of the 2025-2026 academic year.

Information provided to the Upward Bound Program is protected in the Privacy Act of 1974 and will be kept confidential. If you choose not to provide this information to Upward Bound and the U.S. Department of Education, you are not eligible to participate in the program.

We (student and parent/guardian) have read the above information and consent to the release of academic records to the Upward Bound Program at the University of Wisconsin-Superior.
Student Name *
Student Lunch Number *
Student Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Name *
Parent/Guardian Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.