link


ALUMNI TRACKING FORM
Date:
Name:
Upward Bound (UB) is required to maintain contact with its graduates through college graduation. To help UB do that, please provide the following information.
Permanent home address:
Phone#:
Current address:
Phone#:
Email address:
List two people who are not members of your own household who will always know your address.
A. Person 1
Name
Address
Phone
City
State
Zip
B. Person 2
Name
Address
Phone
City
State
Zip
 
Select year of graduation
Married
Husband's or wife's name
Please list name and address of any schools you attended since high school.
School name
Mailing address
City
State
Zip
 
Please check
If you are not in college please check reason(s) why?
 
My plans regarding next year are
Check all that apply:
 
If you are currently a student please complete the following information:
 
College grade level
G.P.A.
Number of credits
Name of College / Technical school or current employer.
Date started
Date you graduated or will graduate from technical school / college
Degree / Certification type
Major field of study
I received financial assistance from the following sources:
List Scholarships:
Thank you for completing this form. Keep in touch at jsulliva@MineralArea.edu or visit our web site at www.mineralarea.edu/UpwardBound . We'd enjoy hearing from you.
Children
Children's Name(s)
Your experience with Upward Bound can provide us with valuable information about how to improve the program. Please answer the following questions.
What Upward Bound activities best prepared you for college?
What Upward Bound activities were not helpful to you?
What activities can Upward Bound offer current students to better prepare them for college?




Mineral Area College      5270 Flat River Road     P.O. Box 1000 Park Hills,      Missouri 63601        (573) 431-4593