Your Personal Information
First Name:
Middle Name:
Last Name:
Maiden Name:
Name of High School:
High School Graduation Year:
Your Current Contact Information
Current Address:
Current City:
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Current Zip:
Phone:
Cell Phone:
Email:
Web Page URL:
Your Permanent Contact Information
(someone who will always know where you are - e.g. parents, guardian)
First Name:
Last Name:
Address:
City:
---------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Zip:
Phone:
Relationship:
Current Educational Status Information
Please select your current status:
attending college full-time
attending college less than full-time
varied enrollment over past year
attending vocational/technical training
completed college or vocational training
completed high school, but not enrolled in a program of postsecondary education
Current Occupational Status Information
Please select your current status:
employed full-time
employed less than full-time
armed services
unemployed
other
Occupation:
Employer and/or Field:
PSI (Postsecondary Institution) Information - First Entry
Please enter information in this section pertaining to your first enrollment in college.
If you have transferred to a new college, graduated from college, or are otherwise no
longer enrolled in a postsecondary institution, please also complete the Current or Most
Recent Enrollment Information section.
Name of first college or
vocational school attended:
Location (City, State):
Start date:
End date:
Major:
Minor:
Financial Aid Awarded:
(check all that apply)
1 - Pell grant only
2 - FFEL Loan
3 - Direct Loan
4 - College work study only
5 - Institutional aid only
6 - State grant only
7 - Pell grant and FFEL loan
8 - Pell grant and Direct Loan
9 - Multiple Federal Aid
10 - Multiple Federal and other aid
11 - Non-federal, non-institutional aid
12 - No aid awarded
13 - No aid needed
99 - Not applicable; not enrolled in college
Current or Most Recent Enrollment Information
Please complete this section if you are continuing your postsecondary education,
have graduated from college, or are otherwise no longer enrolled in college.
The information should be current as of today's date.
Name of current or most recent college or
vocational school attended:
Location (City, State):
Start date:
End date:
Major:
Minor:
Current College Grade Level:
Accepted into PSI but not yet enrolled
1st Year, never previously attended
1st Year, attended before
2nd year/Sophomore
3rd year/Junior
4th year/Senior
5th year/other undergraduate
Enrolled in a graduate degree program
Degree or certificate completed; not enrolled
Completed Associate's Degree; enrolled in 4-year institution
Left program of postsecondary education before completion
Completed high school, but not enrolled in a program of postsecondary education at this time.
Degree/Certificate Completed:
Certificate/Diploma for occupational, educational program
(less than a two-year program)
Certificate/Diploma for occupational, educational, technical
program (at least a two-year program)
Associate Degree (two years)
1st Bachelor's Degree
2nd Bachelor's Degree
Teaching Credential Program
Graduate or Professional Degree
Not yet completed program of postsecondary study
Completed high school; not enrolled in a program of postsecondary education
Today's date:
Alumni Directory
Do you grant permission to Marist Upward Bound to include your current contact information
in an alumni directory to be made available to other Marist Upward Bound graduates, if one is created?
Yes
No
Alumni Spotlight
We would like to periodically feature updates on the activities of our
Marist Upward Bound graduates, both online and in newsletters. We ask
those interested to please provide more detailed information below and to
send us photos - "then" and/or "now" -- by mail or e-mail. Do you grant
permission to Marist Upward Bound to feature you online or in print in our
"Alumni Spotlight?"
Yes
No
Participation in Marist Upward Bound Events
Would you be interested in volunteering to share your college/graduate
experiences with our current Upward Bound students, either as a guest
speaker, college tour guide, workshop facilitator, or in some other capacity?
Yes
No
Not at this time; perhaps in the future.
Additional Comments/Marist Upward Bound Alumni Search:
Do you know the names/whereabouts of any other Marist Upward Bound
graduates? If so, please direct them to our website or enter their
contact information below, along with any additional comments you may have
or information you would like to share with us.
Additional Comments: