upward bound application - haskell indian nations …向上的约束应用haskell印度国家…

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1、HASKELLINDIANNATIONSUNIVERSITYUPWARDBOUNDAPPLICATIONSTUDENTINFORMATIONSTUDENT’SNAME_________________________________________________lastfirstmiddleADDRESS_______________________________________________________streetaddressorPOboxcitystatezipcodeCONTACTINFORMATION_____________________

2、________________________homephonealternatephone____________________________________________________________________emailaddressMySpaceorfacebooknameCURRENT(TARGET)SCHOOL_____________________GRADE_______PHONE___________ADDRESS:___________________________________________ADULTEMERGENCYC

3、ONTACT:________________________________PHONE___________DATEOFBIRTHmm/dd/yy//GENDERofemaleomaleSOCIALSECURITY#--ETHNICITY:oBlack/AfricanAmericanoHispanic/LatinooNativeAmerican/NativeAlaskanoAsianoNativeHawaiian/PacificIslanderoWhite/CaucasianoOther______________________________USCITIZ

4、EN?oYesonoIattesttothefactthattheaboveinformationistrueandaccuratetothebestofmyknowledge.IunderstandthepurposeoftheUpwardBoundproject,whichistoprepareparticipantstosuccessfullycompleteaprogramofpost-secondaryeducation.Aspartofmypersonaleffortinthispreparation,IcommittoUpwardBoundandi

5、ntendtoparticipateinallacademicyearandsummercomponentsoftheproject.Iunderstandthatattendanceisanintegralpartofparticipating.Hence,Iagreetoattendandactivelyparticipateinallclasses,meetingsandactivitiessponsoredbyUpwardBound.IwillcomplywithallrulesandregulationsoftheUpwardBoundproject,

6、andIamawarethatfailuretocomplycouldresultindismissalfromtheproject.Iunderstandandwillinglycommittomeetingtheseexpectations.___________________________________________________________________Student’sSignatureDate___________________________________________________________________Paren

7、t/Guardian’sSignatureDate14HaskellIndianNationsUniversity(HINU)UpwardBound2009Parent/GuardianEducationandIncomeInformationStudent’sName:_________________________________________Studentliveswith:parent(s)orguardian(s)motherfatherother(pleasespecify)___________________TotalNumberLiving

8、inHousehold: