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Upward Bound Summer Program

First Name

Middle Name

Last Name

Email Address

Country

Street

City

Region

Postal Code

Phone Number

Citizenship

Are you Hispanic or Latino Descent

Race

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Relationship

Parent/Guardian Email

High School Name

Graduation Year

Cumulative GPA

Privacy Act Notice:

The University confidentially maintains your personal information including birthdate and Social Security Number(SSN) or Individual Taxpayer Identification Number(ITIN) for routine uses such as, facilitating document matching, verifying your identity, and expediting your enrollment and financial aid. Disclosure of your SSN or ITIN is voluntary, but failure to provide your birthdate and/or SSN or ITIN may result in confusion regarding your identity, and once admitted, could result in delay or loss of federal and state financial aid, tax credits, student loan deferments, veteran benefits, and other benefits under law. If you do not wish to disclose your SSN or ITIN number on this form, or if you do not have an SSN or ITIN number, enter "1" in that field.

Clery Act:

Each year SUU’s Police Department publishes an Annual Security & Fire Safety Report (ASR/AFSR) with updated crime statistics and information intended to inform the SUU community, including prospective students, about the institution’s safety- and security-related policies, procedures, and programs. SUU is required by law to share this important information with you. You can download the most recent version of our Annual Security & Fire Safety Report at https://www.suu.edu/clery/. You may also request a paper copy of this report from the SUU Police Department by visiting their offices at 36 N. 300 W., Cedar City, UT 84720 or by calling (435) 586-7793.

Southern Utah University is required by federal regulations to distribute our Drug and Alcohol Abuse Prevention Program (DAAPP) Disclosure to all students and employees. Please review with careful consideration. You can find and download a copy of the SUU DAAPP Disclosure athttps://www.suu.edu/health/daapp/.

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