THE ACADEMY 2014
Four Corners Upward Bound Math Science Summer Component
Returning Participant Application
You are invited to apply to continue to participate in the Four Corners UBMS Program summer component to live on the Northern Arizona University campus and take the regular Four Corners Upward Bound Program classes as part of the 2014 Academy On:
(Class of 2014) Sat. May 31 – Sat. June 28, 2014 and (Senior Trip) Mon. July 7 – Fri. July 11
(Class of 2015) Sat. May 31 – Sat. June 28, 2014
The promptness of your application and the quality of your answers will be important factors contributing to your selection. With this in mind, please put your best effort into the quality of your responses.
You will recall the standards required for students to be immediately accepted to participate in the summer component of the program are to : 1) Earn at least a ‘C+” (75%) in all core classes in both the fall and spring semesters and 2) to complete at least 75% of the Four Corners UBMS College-Prep Assignments in the fall and spring semesters.
1. Are you currently on track to meet the standards listed above?
⃝ Yes my academic progress is at least satisfactory.
⃝ No my academic progress is at not satisfactory at this time.
a. The major reason I am not meeting the required standards is … (Please explain and give examples)
b. What will you do differently to improve your performance?
2. Name one important goal you want to accomplish in the summer to contribute positively to the 2014 Academy. Describe how you will accomplish your goal.
Your answer should meet the following requirements:
* 2 – 3 paragraphs * complete sentences
* proper spelling and grammar * typed responses
Make it a Specific, Measurable, Achievable, Time bound (SMART) goal by including answers to the following questions:
a) What is your goal, state it specifically?
b) How do you know it is achievable?
c) Will sharing your goal with someone make it more achievable?
d) Who will you share your goal with to ensure you will achieve it?
e) How will you know you have achieved it?
f) By which week in the Academy will you have achieved your goal?
3. Would you like to apply to any other math and/or science summer programs that partner with the Four Corners UBMS Program? If so, which ones. (See explanation, descriptions and websites of some eligible programs we suggest below*)
We encourage participants who have experienced the Academy to explore more specific and rigorous areas of science, technology, engineering or mathematics (for example university level math, health professions, engineering etc.) by also applying to other math and/or science summer programs that partner with the Four Corners Program.
Joaquin Bustoz Math-Science Honors Program http://mshp.asu.edu/
This is an intensive academic program that provides motivated students to begin university mathematics and science studies before graduating high school. Students are required to have completed Algebra I , Geometry and Algebra II by May 2014. Applicants are also required to pass a math placement test.
MedStart
http://uaforyou.arizona.edu/resource/med-start-summer-program-office-outreach-and-multicultural-affairs-oma
Med-Start is a summer academic enrichment program for any 11th grade Arizona high school student interested in a health career. Students participate in the program during the summer between their junior and senior years.
All materials must be received no later than 5:00 PM on February 1, 2014
Native American Science and Engineering Program http://eao.arizona.edu/nasep
NASEP seeks Native American students that are highly interested in Math, Science, and Engineering fields, motivated to be a top student, dedicated to attend college, and have the desire to challenge oneself to new experiences and people.
Nizhoni College-Prep Summer Enrichment Program
http://nau.edu/Nizhoni-Academy/
A pre-college enrichment program designed to prepare Native American High School students to become successful College students. It emphasizes rigorous instruction in Science, Technology, Engineering and Math. Nizhoni participants take different classes than Four Corners Upward Bound Math Science students. They live in the same residence hall and eat in the same dining hall.
*If a Four Corners participant is selected to another math/science summer program that occurs the same dates as the Four Corners Program he/she must notify the Four Corners staff in writing (e-mail is acceptable) that he/she will not be able to participate in the regular 2014 Four Corners UBMS summer curriculum and provide the name and location of the program he/she will attend. This will allow the participant to continue in the Four Corners program in the fall and spring semesters. Many other programs may be suggested for partnerships (some restrictions apply such as federally funded programs for example regular Upward Bound, Talent Search and Gear-Up programs may not partner with Upward Bound Math Science Programs) for details please contact Terry Hubbard
Parent or guardian questions: Please answer the questions to the best of your ability.
1. How long has your student been participating in the Four Corners Upward Bound Math Science Program?______
2. What changes have you observed in your student over this time period?
3. Do you feel your student would benefit from continuing to participate in the Four Corners Upward Bound Math Science Program? _____Yes _____No
If yes, what do you expect your student to gain from participating in the spring and summer components? What more would you like to know about the spring semester what about the summer component on the Northern Arizona University campus?
If not, please explain.
4. Would you like your student to gain experience participating in a more rigorous summer component that concentrates more deeply in an area such as mathematics, engineering, health professions etc. If so, please read the statement regarding other summer programs in the student section above. Do you feel your student is ready to participate in one of these more specific and rigorous math/science summer experiences and continue to receive Four Corners UBMS services in fall and spring?
5. What are you willing and able to do to assist your student in preparing for a career that requires a strong foundation in science, math, engineering or technology?
THE ACADEMY 2014
Four Corners Upward Bound Math Science
Returning Participant Application
Please type or print. Complete entire application thoroughly, and leave no blank spaces.
STUDENT INFORMATION
Applicant (Last, First, MI)Address
Dorm Address (if applicable)
Home Phone
Cell Phone
Email: / How often do you check email?
Which do you prefer we contact you by: Home Ph____ Cell Ph____ or email_____
Sex / _____ Male / _____ Female
Date of Birth
T – Shirt Size / ____Small ____Medium ____Large ____X-Large
____2X-Large
Student School Information
Current Class Year: / ____Freshman ___Sophomore ____Junior ____Senior
High School Name:
Counselor Name:
Counselor Phone Number:
Counselor email:
PARENT/GUARDIAN INFORMATION:
Mother/Female Guardian (Last, First)Address (if different from applicant)
Home Phone
Cell Phone
Work Phone
Email / How often do you check email?
Which do you prefer we contact you by: Home Ph____ Cell Ph____ or email_____
Father/Male Guardian (Last, First)
Address (if different from applicant)
Home Phone
Cell Phone
Work Phone
Which do you prefer we contact you by: Home Ph____ Cell Ph____ or email_____
PARENTAL STATUS:
Married / Parents Separated / Divorced / Father DeceasedMother Deceased / Both Parent Deceased / Other ______
WITH WHOM DO YOU LIVE?
Both Parents / Mother / Stepfather / Father / StepmotherMother Only / Father Only / Other (please explain) ______
Have you participated in Talent Search this semester? ______Yes _____NO
If Yes, who was your advisor?EMERGENCY CONTACT INFORMATION
Please list 2 emergency contact people – other than parents/guardians.
Contacts must have a telephone number
Name / Relationship / Home / Cell # / Work #1.
2.
STUDENT / PARENT SIGNATURES
Both parent and student must read the following statement
and sign below.
All of the information provided on this form is true
and complete to the best of my knowledge.
I take 100% responsibility for my success at The Academy.
I agree to abide by all program policies & guidelines (while on the NAU campus, at any Four Corners function, or while traveling via school/program transportation.) I will complete at least 75% of the Four Corners UBMS Academic Year Assignments and maintain at C+ GPA.
Student Signature Date
I fully support my student’s participation in The 2014 Academy.
Parent/Guardian Signature Date
Application Deadline: November 29th by 5:00 p.m.
Call Laurie 928-523-1351 or Terry 928-699-1138 with any questions
Submit before or on the deadline via one of the following methods
E-mail: or;
Fax: 928-523-9466 Attention Laurie Balenquah
Post Marked To: Laurie Balenquah P.O. Box 6035, Flagstaff, AZ 86011
Participants will be notified in writing of their status with the summer component postmarked by February 7, 2013