Texas Tech University

Summer Commuter Form

Please Fill Out the Form Below. Fields Marked with * ARE Required.

Only complete this form if you are planning to attend the Summer Program. (Must be able to attend the Summer Program at least one day per week).

Texas Tech University Upward Bound Programs (UB) offers a summer component for students to participate in unique hands on instruction, cultural events, and recreational activities. Instruction is provided Monday-Thursday from 8am-3:30pm in Math, English, Science, Foreign Language and Career Preparation/Exploration. Study hall and tutoring is available from 3:30-5pm for those who need to remain on campus longer. On Fridays, summer participants attend various cultural and recreational events from 8am-5pm. Summer participants are expected to commute to class each day and will be provided with breakfast snacks and a full lunch at no cost.

Day/timeEvent
Monday-Thursday,8am-3:30pmHands On Instruction (breakfast snacks & lunch provided)
Monday-Thursday,3:30pm-5pmStudy Hall & Tutoring
Friday,8am-5pmCollege Tours or Recreational Activities (breakfast snacks & lunch provided)

First Name:*
Last Name:*
Grade Level (Summer):*
Program:*
T-Shirt size:*
1.If you have any activities that conflict with the summer component dates, please indicate the dates and the specific activity. (This includes activities such as, cheerleading camp, Boy's State, Girl's State, Science Symposium, personal events, vacations, etc.)
Activity:Date:
Activity:Date:
Activity:Date:
2.Will you be working this summer during the UB Summer Component (May 31 – June 30)?* Yes
No
 
Where:
Work Phone:

(xxx-xxx-xxx format only)
Place of Employment:
Job Title:
Supervisor:
Tentative work schedule
Monday
Tuesday
Wednesday
Thursday
Friday

I verify and acknowledge that this is true and accurate to the best of my knowledge and I will be able to attend class at least ONE weekday per week from May 31 to June 30, 2016.

 I Agree*

Student's Full Name: *
Today's Date:                                              12/12/2017

Contact

Upward Bound