Upward Bound Math and Science at

Trinidad State Application


First Name


Student Information

Everything with an asterisk * is required.


First Name *
Last Name *
Gender *
Local (Physical) Address *
City *
State *
Local Zip *
Permanent (Mailing) Address *
Permanent (Mailing) City *
Permanent (Mailing) State *
Permanent (Mailing) Zip *
Student Email Address *
Student Cell Phone Number *
Entry Grade Level *
Hispanic (1 = YES, 2 = NO) *
American Indian/Alaskan Native: *
Asian *
Black or African American *
White *
Native Hawaiian or Other Pacific Islander *


Emergency Contact Information

Everything with an asterisk * is required.

Emergency Contact 1 Name *
Contact 1 Address *
Contact 1 City *
Contact 1 State *
Contact 1 Zip *
Contact 1 Cell Phone *
Emergency Contact 1 Email Address *
Contact 2 Name
Contact 2 Address
Contact 2 City
Contact 2 State
Contact 2 Zip
Contact 2 Cell Phone
Emergency Contact 2 Email Address
Parent's Most Recent Tax Return, Signed Statement of Income, or verification from another government source: *


Upload Section Required Documents

*make note of the following income limits.


2/3 of our cohort must be both Low-Income and First generation college (meaning parent(s) make equal to or less than the amount in the link, and parent(s) do not have bachelor's degrees). The remaining 1/3 can be one of two (either/or).

1. One of the following three financial statements:
a.Most recent tax return, 
b.a signed earning statement by parent/guardian, 
c.or verification from another government source.  
2. photocopy of student's social security card
3. High School Transcript
4. Personal Statement of Interest & Goals
5. Academic Letter of Recommendation (to be authored by a teacher, counselor, principal, etc., who can attest to the student's desire to learn).
6. Personal Letter of Recommendation  (to be authored by a nonfamily member, priest, pastor, employer, family friend, etc., who can attest to the student's character).
7.College transcripts (if student is in dual credit/concurrent enrollment)


Photo Copy of Social Security Card: *
High School Transcript (or Middle School Record if you are an 8th grader aka rising freshman): *
Personal Statement of Interests and Goals: *
Academic Letter of Recommendation: *
Personal Letter of Recommendation: *


Upload Section: Supporting

 Documentation not required

unless applicable.


College Transcript: