Upward Bound
TTU Home Division of Institutional Diversity, Equity & Community Engagement Upward Bound Early Dismissal Request Form

Early Dismissal Request Form

Please enter your information. ALL Fields are REQUIRED

Student Name:
High School:
Grade Level:
Upward Bound Group:
Date of Early Dismissal (Click to Select):
Dismissal Time (Click to Select):
Parent or Guardian Name:
Telephone Number were Parent or Guardian can be Reached:
Secondary Telephone Number:
Reason for Dismissal:
Email Address:

Please read and sign the following statement:


I verify the information provided above is true and accurate to the best of my knowledge. Any deliberate falsification of information is considered grounds for termination from the program.

I Agree


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