Thank you for your interest in our Upward Bound program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (406)496-4690.
General Information:
Which program are you applying for? *
First Name *
Middle Name
Last Name *
Preferred Name
Social Security Number *
Gender
Date of Birth *
Address 1 *
Address 2
City *
State *
Zip *
Home Phone Number *
Students Cell Phone Number
Parent's Cell Phone Number *
Student's Email Address *
Parent's Email Address *

Ethnicity/Race/Eligibility

Fill out this section completely.

Select all that apply with a "1", and select all that DO NOT apply with a "2"
Are you a citizen, national, or permanent resident of the U.S.?
Native Hawaiian or Other Pacific Islander *
Asian *
Black or African American *
Ethnic (Hispanic) *
White *
American Indian/Alaskan Native *
Do you have any disabilities? *
Academic Info:
Describe your primary reason for applying *
Current Grade Level *
Current School Attending *
How many classes are you taking?
Do you plan on taking a College Entrance Exam this year?
If Yes, which one?
What are your Educational Plans? *

What services are you interested in receiving? (Select all that apply)
Academic Advising
ACT & SAT Preparation
Career Planning & Exploration
College Planning & Exploration
College Visits & Cultural Field Experiences
Financial Aid Information (including Scholarships)
Financial & Economic Literacy
Mentoring and/or Tutoring Opportunities
Summer Activities
List any colleges/universities that interest you.

Essay Questions:

Students are required to submit a minimum one paragraph response to each of the following questions.
1. Explain the steps you will take to achieve your college & career goals after high school.
*
2. Describe your hobbies/interests outside of school.
*
3. Describe the academic areas in which you experience difficulties learning.
*
4. Explain why you want to participate in MTUB. Please highlight how you plan to benefit from your participation in MTUB
*
Family Information:
Contact 1 Name *
Parent/Guardian Marital Status *
Parent/Guardian Cell Phone Number *
Parent/Guardian Home Phone Number *
Parent/Guardian Email Address *
With whom does the student live? *
If "Other" who?
How many people in your household? *
Did either Parent/Legal Guardian that you live with earn a Bachelor's (4 year) Degree?
Select *
If "Yes" who?
Does the student qualify for free or reduced lunch?
Do you receive public assistance such as SNAP, TANF, etc.? *
Is the Student a Ward of the State? *

Last Year's Taxable Income:

Montana Tech Upward Bound is federally funded and requires verification of every participant’s income. Please check your TAXABLE income for the previous year (line 15 on Tax Form 1040).  By signing this form you are certifying the income information provided is accurate and may be used to determine student eligibility. 
Taxable Income *
Emergency Contact:
Emergency Contact Name *
Emergency Contact Relationship *
Address *
City *
State *
Zip *
Home Phone *
Cell Phone
Email Address *

Commitment Contract:

Montana Tech Upward Bound (MTUB) is a unique partnership between you (the student), parents and/or guardians, MTUB staff, and high school officials. It is critical that all parties involved share responsibility and work together as a whole to ensure your success in the program. Please read the following commitments carefully, as your signatures indicate you understand the commitment MTUB expects. 
I, the Student, commit to
1) Attend high school regularly; this includes classes, labs, and discussions. Regularly means every day unless you have an extenuating circumstance that you discuss with MTUB staff so they can assist you through advocacy if needed.
Select *
2) Enroll in an academic rigorous core in accordance with entrance requirements for the Montana University System.
 
Select *
3) Earn and/or maintain a cumulative 2.50 GPA while in the program. Your GPA may be lower at the time of acceptance, but you must have the ability to achieve a 2.50 GPA by the next semester.
 
Select *
4) Attend all weekly meetings and Saturday field experiences with the MTUB staff. When you are unable to attend, you will check in with MTUB staff prior to the event.
Select *
5) Display behavior and attitudes that are respectful and appropriate for college success preparation. For further explanation, please see the MTUB Scholars Expectations handout.
Select *
6) Attend at least two summer academies before high school graduation.
 
Select *

Dismissal Policy:

If you fail to maintain the commitments listed above you will be on probationary status and must schedule a meeting with the MTUB staff to create an action plan. Depending on your action plan progress, your probationary status will be removed. Upon removal of probationary status you will be fully reinstated into the program. If your progress is satisfactory, you will be re-evaluated for continued probation. However, if satisfactory progress was not achieved you will face dismissal from the program for not upholding the commitments put forth in this contract.
Select
I, the Parent or Legal Guardian, commit to
1) Give permission for my child to participate in the MTUB program.
 
Select *
2) Support my child's involvement in the MTUB program, assisting when necessary.
 
Select *
3) Attend MTUB activities involving parents during the year.
Select *
I, the MTUB, Staff commit to
1) Meet with each student on a regular basis to provide information, tutoring, and activities that will help them to achieve their full potential.
 
2) Seek parental input and involvement in MTUB activities and planning when necessary.
 
3) Work closely with parents/guardians and school personnel to ensure each student is receiving the best comb nation of services.
Because of the money and energy invested in each student (approximately $4,000 per student per year), MTUB cannot afford to support students who are not serious about academic success or pursuing higher education.  
We have read the commitments and the probation and dismissal policy above, and we agree to adhere to the conditions set forth. 
Medical Release:
I,