Section I - General Information

Please note that all fields marked with an asterisk (*) are required.

Section II - Educational Information

Please note that all fields marked with an asterisk (*) are required.

Section III - Employment Information

Section IV - Military Information

Section V - Questionnaire

1. If currently attending college/university, does your campus offer Student Support Services? Yes No Unsure
   If so, are you taking advantage of the services? Yes No Not applicable
2. If you did not enroll in a college or university, please provide your reason(s) for not attending.
   
3. If you are not currently enrolled in college, what is the likelihood that you will be returning to school? Very Likely Somewhat Likely Not Likely
4. If you answered 'very likely' or 'somewhat likely' to question 2, would you like for us to refer you to a fellow TRIO Program that may be able to assist you in returning to school? Yes No
5. Do you feel that Upward Bound Math and Science Center was of assistance to you in establishing and/or meeting your college/career goals? Please explain your answer below.
   
6. In what areas do you feel Upward Bound Math and Science Center could have better prepared you for life after high school? Please explain your answer below.
   
7. Any additional comments, requests, ideas or suggestions for improvement?
   
8. Would you be interested in attending an alumni reunion? Yes No

Section VI - Submit Your Information

Thank you for taking the time to complete this form. If we may be of further assistance to you, please do not hesitate to contact our offices. Don't forget to visit us on the web at Upward Bound Math & Science Center.