PRE-APPLICATION CARD

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Upward Bound Programs
Doak Hall Room 119G
Ph: (806)742-3616
Fax: (806)742-0983
Texas Tech University, Lubbock, TX 79409-4012
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First Name: Last Name:
School: Grade:
Mailing Address:
City/State/Zip:
Best Time to Call:(Day) (Time)
Email Address:
Home Phone: Cell Phone:
Parent/Guardian Name(s):
Plans after High School: 4-YearCollege Work Vocational/Technical Training 2-YearCollege Military Undecided
Top3 Career Choices: 1) 2) 3)
Do you receive: Free Lunch Reduced Lunch Neither Did Not Apply
# of Family Members in the Household:
Did your parents/guardians graduate from a 4-Year College? : Yes No
# of siblings who have graduated from college:
Do you have access to a computer or internet at home? : Yes No
Are you a LEARN , Talent Search participant? : Yes No
What is your parent/guardian primary language?:

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PRE-APPLICATION CARD