Student Application - Long Beach City College
ADVERTISEMENT
1
2For UB office use only
Income
Education
L O N G B E A C H C I T Y C O L L E G E
U P W A R D B O U N D P R O G R A M
Application for Admission
P
I
ERSONAL
NFORMATION
1) Name
2)
-
-
Last
First
Middle
Social Security Number
Note: All Applicants Must Have a SSN
3) Home address
Street
Apt. #
City
State
Zip
4) Email address
5) Telephone (
)
6) Male
Female
Area
7) Birthdate
/
/
Birthplace
Month
Day
Year
City, State, Country
8) Ethnicity
or
Black
African American
White
American Indian/Alaskan Native
Asian
Hispanic/Latino
Native Hawaiian/Pacific Islander
Other
9) Are you a U.S. citizen?
Permanent Resident?
Resident Card Number
Yes
No
Yes
No
10) Do you have any physical condition or disability which requires special treatment, or are
you under any special medication? Yes
No
If “Yes,” please explain:
11) High school
Current grade level
Counselor’s name
Overall G.P.A.
12) How did you hear about the Program?
13) Do you have a sister or brother in the Program? Name?
14) Are you involve in any other college preparatory program, such as EAOP, Talent Search or
Cal-SOAP?
Essay
On a separate sheet of paper, please submit an essay which discusses: 1) your interests, 2) your
educational and professional goals, and 3) your desire to participate in the Long Beach City
College Upward Bound Program. Please do not use a pencil.
4901 E. Carson, Long Beach, CA 90808 tel. (562) 938-5178 fax (562) 938-5112
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business