Register for the 2020 Summer Program by May 31! |

“Pathways, Passion & Purpose”

Summer Program Dates: June 22 – July 31

All Upward Bound Tacoma students are welcome! Yes you too, 2020 grads!

We know times are hard right now. Let’s be here for each other and make the summer the best we can make it!

Thanks to all the students, staff and community members who helped shape this year’s first ever virtual summer program. Watch the slides below to learn more about your summer teachers and success coaches. The last slides give an overview of the whole program. If you have any questions, just reach out to us!

2020 Upward Bound Summer Learning Institute Registration

Student Information

First Name *

Last Name *

Birthday *

What is your phone number? *

Email *

Confirm Email *

T-Shirt Size

X-Small

Small

Medium

Large

X-Large

XXL

Physical Address (to drop off supplies) *

Physical Address (to drop off supplies)

City

State/Province

Zip/Postal

Country

Mailing Address (if different from physical address) (to mail supplies)

City

State/Province

Zip/Postal

Country

Which program? *

Which school are you from? * Which school are you from?

Graduation Year *

2020

2021

2022

2023

What college are you planning to attend this fall? (If unsure, just write unsure)

Classes & Workshops

Which Career Pathway Class is your top choice?

Which Career Pathway Class is your second choice? *

How excited are you for English class? (1 = not at all, 10 = very excited) *

How excited are you for Forensics class? (1 = not at all, 10 = very excited)

How excited are you for Ethnic Studies class? (1 = not at all, 10 = very excited)

How excited are you for Lyceum/Culture Nights (ie: guest artist performances and community forums)? (1 = not at all, 10 = very excited)

How excited are you for workshops with college students? (1 = not at all, 10 = very excited)

Which types of workshops are you most interested in?

Financial Literacy (FAFSA, scholarships, loans, credit, etc)

Time management & study skills

Art

Cooking

Study sessions

Music

Poetry

Virtual field trips

How to be successful

OtherOther

Do you have any suggestions for your teachers, advisors and/or success coaches to best support your learning?

Technology Survey

Do you have a laptop or computer at home? *

Yes

No (we will provide you with a laptop to use throughout the summer program)

Do you have internet at home? *

Yes

No (we will help you sign up for the TRIO Comcast Internet Essentials program)

How comfortable are you with navigating Zoom? (1-5, 1 = not comfortable, 5 = very comfortable) *

How comfortable are you with navigating Canvas? (1-5, 1 = not comfortable, 5 = very comfortable)

How excited are you to take online classes? (1 = not at all, 10 = very excited) *

Summer Meals

Upward Bound will provide meals for students participating in the Upward Bound Summer Learning Institute. The pickup locations will be determined based on where students live. Which location would you be able to pick up your meals from? *

If circumstances allow, would you want to have physically distanced lunch together outside at your pick up location?

Yes

I would want to, but won’t be able to

Would you like to have the opportunity to cook your own food for some of your meals this summer if UB supplies the food? *

Yes

Do you have any restaurant recommendations? Please list if so.

Do you have any food allergies? Please list.

Do you require vegan or vegetarian meals? Please write which one.

Emergency Contact Information

Parent/Guardian Full Name *

Parent/Guardian Phone Number *

Parent/Guardian E-Mail Address *

Emergency Contact Full Name & Relationship to Student *

Emergency Contact Phone Number *

Emergency Contact E-Mail Address *

Medical Release

Do you have health insurance? *

I do NOT have health insurance. Not having health insurance will not affect how Upward Bound responds to a medical emergency or the care we seek on behalf of your student.

I have health insurance and my insurance card is attached below.

Insurance Name, ID number, Group Number & Phone Number *

Parent/Guardian Initial: I hereby grant permission for the Upward Bound program, or an Evergreen State College authorized representative, to provide first aid as my student (named above) may require, as well as to seek medical attention through the nearest medical facility. This permission is conditioned upon the understanding that, in the event of serious illness or the need for hospitalization and/or major surgery, the program will exhaust all reasonable efforts to contact me. Failure in such efforts, however, should not prevent the program from seeking emergency treatment as may be necessary for the best interest of the life of my student. *

Program Agreements: Both parent/guardian & student initial each statement.

I want (my student) to participate in the 2020 Summer Learning Institute and give permission for their full participation. *

I understand that Upward Bound will make arrangements, register for events, order supplies and commit funds based on the information I provide in this application. I will do my best to ensure my student actively commits to 100% participation in all components of the 2020 Summer Learning Institute. *

I understand that full participation is required and that 2 or more absences (at required classes, workshops & meetings) and/or missing assignments will prevent you from earning the full stipend and/or credit, and could result in being excused from the summer program. *

I understand that all Upward Bound employees who have reasonable cause to believe that a child has suffered from abuse or neglect, including physical injury, sexual abuse, sexual exploitation, negligent or maltreatment, shall report such incident. *

I will notify Upward Bound Staff of any emergencies or absences that could cause my student to miss any portion of the UBSLI. (Notify your teacher, advisor or success coach) *

I consent to release the image and voice (photos, video, sound recordings, etc) of my student for public media, such as newletters, websites, newspapers, magazines, news broadcasts and documentaries.

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2020 Upward Bound Tacoma Summer Learning

The Evergreen State College

Register for the 2020 Summer Program by May 31!

“Pathways, Passion & Purpose”

Student Information

Classes & Workshops

Technology Survey

Summer Meals

Emergency Contact Information

Medical Release

Program Agreements: Both parent/guardian & student initial each statement.

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