Upward Bound Info Requests

Upward Bound Interest Card header

Request More Information about Upward Bound

About You

First Name:

Last Name:

Phone Number:

If possible, please enter an email address that it not your school email.
Some school email addresses restrict incoming emails from outside domains.

Student Email Address:

Confirm Student Email:

Alternative Email:

Information about your Parent/Guardian

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent Phone:

Parent Email:

Confirm Parent Email:

Alternative Parent Phone:

Guardianship information Is the student a foster child, a ward of the State, or in the custody of a public child welfare agency?

Yes No

The Federal TRIO Programs Current-Year Low-Income Levels shown below is used to determine the family's income eligibility (based on taxable income) as required by the U.S. Department of Education. Family taxable income can be found on Line 15 of the 1040 Tax Form or 1040-SR Tax Form.

Based on the Current-Year Low-Income Levels provided, will the student potentially qualify as low-income? (Compare taxable income only)

Yes
No
Unsure

Do any of the student's parents/guardians have a bachelor's degree?

Yes
No

Federal TRIO Programs: Current-Year Low-Income Levels
(Effective January 2023, until further notice)

Number in Household	Taxable Income
1	$25155
2	$34020
3	$42885
4	$51750
5	$60615
6	$69480
7	$78345
8	$87210

About Your Interests and Education

I currently attend:

Other school:

I am currently in the:

Career(s) I am interested in:

Program interest:

How did you hear about Upward Bound?

Other (please elaborate):

Debug Info (Admin Only)

heard_about    = [{"id":"1","source":"High School Counselor","is_enabled":"1"},{"id":"2","source":"High School Teacher","is_enabled":"1"},{"id":"3","source":"High School Website","is_enabled":"1"},{"id":"4","source":"Current Upward Bound Student","is_enabled":"1"},{"id":"5","source":"Upward Bound Staff Member","is_enabled":"1"},{"id":"6","source":"Upward Bound Flyer","is_enabled":"1"},{"id":"7","source":"Upward Bound Website","is_enabled":"1"},{"id":"8","source":"Upward Bound Information Night","is_enabled":"1"},{"id":"9","source":"Social Media Advertisement","is_enabled":"1"},{"id":"10","source":"Career Fair","is_enabled":"1"},{"id":"11","source":"Radio Advertisement","is_enabled":"1"}]

schools        = [{"school":"Hilo"},{"school":"Honokaa"},{"school":"Kau"},{"school":"Keaau"},{"school":"Kealakehe"},{"school":"Kohala"},{"school":"Konawaena"},{"school":"Laupahoehoe"},{"school":"Pahoa"},{"school":"Waimea"}]

programs       = [{"program":"Upward Bound Classic"},{"program":"Upward Bound Math and Science"}]

income levels  = [16290,25155,34020,42885,51750,60615,69480,78345,87210,96075]

data           = []