You must have JavaScript enabled to use this form. Student Information Your First Name Your Last Name Mailing Address Address City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Email Email Confirm Email Phone Number Date Of Birth Preferred Pronouns (recommended) Preferred Pronouns - None -He/HimShe/HerThey/ThemOther… Enter other… Ethnicity (recommended) - None -American Indian / Alaskan NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific IslanderWhiteUnknown Citizenship United States Citizen Permanent Resident of the United States Identify country of citizenship If accepted, you will be asked to provide a copy of your I-94 form or I-551 ("green card"). High School High School - Select -Chandler Park Academy High SchoolFerndale High SchoolSouthfield High School for the Arts and TechnologyUniversity High SchoolOther… Enter other high school name … Counselor Name Grade Level as of the 2021-2022 School Year Freshman Sophomore Junior Senior Grade Point Average Do you agree to participate in the UBMS program until you graduate from high school?" Yes No Student Narrative Explain your interest in the NMU UBMS program and describe how you may benefit from the program. Discuss your future educational and career goals. Parent/Guardian Information Parent/Guardian Full Name Parent/Guardian Phone Number Parent/Guardian Email Parent/Guardian Occupation (Optional, recommended) Parent/Guardian Employer (Optional, recommended) Name and age of other dependents living in the household Name Age Operations Name Age Add more dependent(s) more dependent(s) Will your parents/guardians file federal income taxes this year? Yes No Number in family unit AND taxable income (this is less than taxable income and is usually found on line 15 of the 1040 tax form) Number in family unit AND taxable income (this is less than taxable income and is usually found on line 15 of the 1040 tax form) - Select -2, under $31,7253, under $39,9754, under $48,2255, under $56,4756, under $64,7257, under $72,9758, under $81,225Other… Enter other… Has your parent/guardian earned a Bachelor's Degree? Yes No Non-taxable Income Sources (Check all that apply) Welfare/SNAP Benefits/MI Bridges Social Security Child Support Workers Compensation Not applicable I agree that everything above is true. Full Name Leave this field blank
