Hibbing Upward Bound Application
Student Information:
First Name *
Middle Name
Last Name *
Date of Birth *
Address 1 (Mailing) *
Address 2
City *
State *
Zip Code *
Student Cell Phone Number
Student Email Address
Social Security Number
Gender *
Please answer yes or no based on how you identify. You can answer yes to more than one option.
American Indian or Alaskan Native *
Asian *
Black or African American *
Hawaiian or Pacific Islander *
Hispanic or Latino *
White *
Academic Information:
Current Grade Level *
Current School Attending *
Do you have an IEP or receive any Special Education services? *
Family Information:
What is the name of your parent that we should reach out to if we have any questions? *
Please enter the phone number of the parent you would like us to contact with any questions. *
Has your mother/first parent/guardian earned a Bachelor's Degree from a four-year college? *
Has your father/second parent/guardian earned a Bachelor's Degree from a four-year college? *
How many people are in your household? *
Please select the range in which your family's taxable income falls? *
Sign and Submit:
Applicant Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:

Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number: