Thank you for your interest in the Colorado State University Pueblo TRIO Upward Bound Program. Please complete this recruitment interest form.

Student Name (First & Last) *

Student Phone/Cell Number *

Student email *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Parent/Guardian email

What middle school do you currently attend(ed)? *

What grade are you in currently? *

What high school do you attend/will attend? *

Do you have a relative or friend in the CSU Pueblo UB Program? *

Yes

No

If so, what is their name and relation?

Thank you for taking the time to complete this interest form. You are one step closer to being college material. We will be in touch with you soon. Way to go!!