The Upward Bound Math & Science Program is a FREE, year-round, college preparatory program funded by the Department of Education and sponsored by Fitchburg State University. Our program provides academic support for high school students through tutoring services, STEM and college prep workshops, college visits, and more! Eligibility is based on first generation college status, family income, and academic motivation.

To be eligible for admission and participation, students must meet the following requirements:

  • be the first in their family to complete a 4-year college degree AND/OR come from a moderate income background (each as defined by the U.S. Department of Education)
  • demonstrate academic need
  • reside in the program's target area (Fitchburg and Leominster)
  • be a U.S. Citizen or permanent resident

Application Process:

  1. Submit the Application Part 1: Student Information (this form)

  2. Submit the Application Part 2: Household Information (to be completed by parent/guardian)

Upward Bound staff will review all completed applications for initial eligibility. Students determined to be eligible will be invited to interview with a program staff member. Following the interview, staff will work with the student to request and obtain a teacher recommendation and any additional documentation.                                                                                    

APPLICATION PART 1: STUDENT INFORMATION

To be completed by the student.

All fields of the application are required to determine program eligibility. Information provided is protected by the Privacy Act.

Student Name
Legal First Name *
Preferred First Name
Legal Middle Name or Initial
Legal Last Name *

Contact Information
Mailing Address *
Apartment/Unit #
City *
State *
Zip Code *
Home Phone
Student Cell Phone
School Email Address *
Personal Email Address *

Demographic Information
Date of Birth (MM/DD/YYYY) *
Gender *
Primary Language Spoken at Home *

Race and Ethnicity:

For each of the following, choose 1 if you identify YES or choose 2 if you identify NO
American Indian/Alaskan Native *
Asian *
Black or African American *
Hispanic/Latino *
Native Hawaiian or Other Pacific Islander *
White *

Educational Information
High School Attended (or will attend) *
Expected High School Graduation Year *
Current GPA (current 8th graders leave blank)
Name of School Counselor *
Please indicate if you are interested in a degree in any of the following STEM related fields:
Biology
Chemistry
Engineering
Computer Science/Technology
Health Sciences
Mathematics
Other Sciences
Please indicate if you are a part of any of the following programs:
GEAR UP
Talent Search
EOC
Another TRIO Program

Parent/Guardian Contact Information

Please submit contact information for a parent/guardian whom we can contact about completing your application.
Parent/Guardian First and Last Name *
Relationship to Student *
Parent/Guardian Email Address *
Parent/Guardian Phone Number

AUTHORIZATION TO RELEASE INFORMATION

By signing below and submitting this application, I hereby authorize any educational institution that I am attending or will attend to release the following academic record information to the Fitchburg State Upward Bound Math and Science Program:

  • Grades
  • Transcripts
  • Course schedules
  • Attendance records
  • Disciplinary records
  • Individual Education Plans and 504 plans
  • Standardized test scores
  • Proof of graduation
  • Proof of enrollment
  • Academic progress toward graduation
  • Financial aid

I understand that the United States Department of Education requires that Upward Bound Programs report on students' academic eligibility and progress from point of admission through either their graduation from college or for at least six years after graduation from high school, and that this information will be handled in strict confidence according to federal regulations.

CERTIFICATION

All of the information in this application is true and correct to the best of my knowledge. If asked by an authorized official, I agree to give proof of the information provided on this application.
Student Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.