Keene State College Upward Bound Programs
 229 Main Street
Keene, New Hampshire 03435-1801
www.keene.edu/upward 

The KSC Upward Bound Programs are federally-funded college preparatory programs that prepare students for success in high school and enrollment in college. 

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

  • be a U.S. Citizen or permanent resident;
  • 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; and
  • attend one of the programs’ target high schools.

Application process: 

  1. Submit Student Application Part 1: Student Information (this form)
  2. Submit Student 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 school counselor report and teacher recommendation. 

Admission into the programs is based on financial eligibility, academic eligibility, and the personal interview. 

STUDENT APPLICATION PART 1 

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
Student's Legal First Name *
Preferred/Chosen First Name
Student's Legal Middle Initial
Student's Legal Last Name *
Suffix (Jr., III, etc.)

Contact Information
Mailing Address or P.O. Box *
Apt/Unit #
City *
State *
Zip Code *
Home Phone
Student's Cell Phone Number
Student's School Email Address
Student's Personal Email Address

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

Race & Ethnicity

Choose "1" if you identify "YES" or choose "2" for "NO"
Hispanic *
American Indian/Alaskan Native *
Asian *
Black or African American *
White *
Native Hawaiian or Other Pacific Islander *

Educational Information
Target High School the Student Attends or Would/Will Attend *
Expected Year of High School Graduation *
Name of School Counselor *
NH students: Are you a participant in UNH ETS (Educational Talent Search)?
VT Students: Are a you a participant in the VSAC Outreach program at your school?

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 Addresss
Parent/Guardian Cell 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 Keene State College Upward Bound Programs:

  • grades,
  • grade reports (report cards),
  • 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, and
  • financial aid.

I also authorize program use of school information systems (e.g. Power School, Jumprope, Enriching Students, Web2school) to access my academic records.

I understand that the United States Department of Education requires the Upward Bound Programs at Keene State College to 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's Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.

APPLICATION SUBMISSION

 Click the button below to submit Student Application Part 1.