University of New Meixco Valencia Campus

Upward Bound Program

1. Name: Last, First, MI
2. Mailing Address: Street City State Zip
3. Parent Phone Number:
4. Student Phone Number:
5. E-mail address
6. Date of Birth: (MMDDYYYY)
7. Gender
8. Social Security Number:
9. High School and Current Grade
Belen High School  
Los Lunas High School  
Valencia High School  
Current Grade   
10. Are you a U.S. Citizen or Permanent Resident?
11. Primary Language:
12. The University of New Mexico is required by Federal law to request this information for statistical reporting purposes. Your response is voluntary.
13. Do you consider yourself to be Hispanic/Latino?
14. In addition, select one or more of the following ethnic categories to describe yourself. 
Black or African America  
Hispanic or Latino  
Native Hawaiian or Other Pacific Islander  
American Indian/Alaskan Native (Your principal tribe)   
15. Are you are a first generation student( neither parent or legal guardian has completed a bachelor's degree from an accredited college)?

Select one of the statements below regarding income that applies to you:

Note: For families with more than 8 persons, add $6,270 for each additional family members

 Total number of people in householdFamily Taxable IncomeExact Income
One person- yourself included$18,090 or below
Two persons- yourself included$24,360 or below
Three persons-yourself included$30,630 or below
Four persons-yourself included$36,900 or below
Five persons-yourself included$43,170 or below
Six persons-yourself included$49,440 or below
Seven persons-yourself included$55,710 or below
Eight persons-yourself included$61,980 or below