Thank you for your interest in the Cornell Upward Bound program! We are excited to receive and review your application.  If you have any questions or concerns while completing this application please do not hesitate to contact us at upwardbound@cornell.edu 

This online form is ONE part of the entire application. Some of the other parts will need to be submitted by parent/guardians and some by prospective students. Here is how it's broken down: 

  • This Online Application Form - Most questions are for parent/guardians and some are for students. Complete this together. 
  • Student Personal Statement - This is a 250 - 500 word essay to be completed by the prospective student answering the question: "What does the future hold for me and how will participating in Upward Bound support my journey?" You can submit this essay by email to upwardbound@cornell.edu
  • Two Letters of Recommendation - Each prospective student will request these from significant adults in their lives who are not family members. For example, teachers, counselor, coaches, clergy, supervisors, other leaders. You will ask your recommenders to send the letters directly to upwardbound@cornell.edu

*This website is encrypted for safety and your information is securely protected.

**Due to the nature of this online platform this application needs to be completed in one sitting. Take a minute to review all the required pieces of the application and gather the materials you will need to submit completely. Some pieces can be uploaded or emailed. Make a plan and please communicate with us! We are looking forward to receiving your application! 
Student General Information
First Name *
Last Name *
Middle Name
Address (number and street) *
Apt or #:
City *
State *
Zip *
Local Phone *
Student Cell Phone Number *
Student Email Address *
Student Date of Birth *
Student Social Security Number *

We ask for the student SSN for federal reporting reasons as well as for support in preparing your family for the college application process. 

This website is encrypted for safety and your information is securely protected. 
Student Gender *
Are you a US Citizen? *
If in process, describe situation and estimated time student will become resident.
Are you of Hispanic or Latinx origin? *
Indicate Student Race *
If you selected some other race or prefer to self-describe please elaborate here:

Student Academic Background Information
School Name *
Current Grade Level *
School Counselor Name: *
We know it's a few years away but when you graduate HS, what do you plan to do? *
If other, what are you thinking?
Right now, what are your favorite subjects and interests? (for example, math, biology, cooking, raising animals, etc.) *
What are some careers and jobs that interest you? *

Family & Household Information

Please list both bio-parents below, even if one or more is deceased and/or no longer has legal responsibilities toward the student applicant. If student is a minor with a legal guardian, please list that information below as well.  The more information we receive, the better we can understand your family, your needs and your application. If you have unique circumstances not covered in this application please email upwardbound@cornell.edu
Parent's Marital Status *
If Divorced, date (MM/YYYY)
With whom does the student applicant make his/her permanent home? *
If Other, please explain:

Parent 1 Information
Name *
Relationship *
Is Parent 1 living? *
If No, date deceased:`
Address: *
Apt or Lot#:
City: *
State: *
Zip: *
Cell Phone: *
Work Phone:
Home Phone: *
Email: *
Occupation / Job: *
Employer: *
Highest Education Received: *
If Other, please explain:
Please list any military experience, if applicable:

Parent 2 Information
Name *
Relationship: *
Is Parent 2 Living? *
If No, date deceased:
Address:
Apt# or Lot#:
City:
State:
Zip:
Cell Phone:
Work Phone:
Home Phone:
Email:
Job / Occupation:
Employer:
Highest Education Received: *
If Other, please explain:
Please list any military experience, if applicable:

Legal Guardian (if other than parent 1 or 2)
Legal Guardian Name:
Legal Guardian Address (if different than student):
Legal Guardian Cell Phone:
Legal Guardian Work Phone:
Legal Guardian Home Phone:
Legal Guardian Email:
Legal Guardian Job / Occupation:
Legal Guardian Employer:
Highest Education Received:
If Other, please explain:
Please list any military experience, if applicable:

Family Financial Information

Please note that all financial information will be kept in the strictest confidence and will only be seen by appropriate Upward Bound personnel to determine students' eligibility for the program. 
Please indicate the number of people who live in the household (including yourself): *

In order to report income please use your Taxable Income from your 2024 federal income taxes, or the last year that you paid taxes, if not 2024. This information can be found on these various tax forms: 

  • 1040EZ on line 6
  • 1040A on line 27
  • 1040 on line 43
Taxable Income is within this range: *

Signatures of Confirmation and Assurance

US Department of Education Statement:


The personal information you give to the Upward Bound Program is protected by the Privacy Act.  No one may see the information unless they work with or for the Upward Bound Project or are specifically authorized to see the information.  This information is necessary to determine if you are eligible to participate in the program and helps the government to measure your success. The Department of Education has the authority to gather information to make Upward Bound a better program (20 USC 1231a). If you do not give this information to the Upward Bound Program and the Department of Education, eligibility can not be determined, and therefore you cannot receive any benefits from the program.

Student Signature

   I, the undersigned, confirm that all the information on this application is true to the best of my knowledge. 
Student Signature *
Signature Type: Simple    Start Over
Click here to start signing.
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Signature: (Type in your full name)
I agree to the terms included.

Parent/Legal Guardian Signature

  I, the undersigned, confirm that all the information on this application is true to the best of my knowledge. 
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.