Upward Bound APR

OMB Approval No.: 1840-0762

Expiration Date:

Upward Bound (UB), Upward Bound Math-Science (UBMS),

and Veterans Upward Bound (VUB) Programs

Annual Performance Report

Program Year 2010–11

Authority: Public Law 102-325, as amended.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. Public reporting burden for this collection of information is estimated to average 9 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit (Title IV, Sections 402A(c)(2) and 402C of the Higher Education Act of 1965, as amended; the program regulations in 34 CFR 645, and the Education Department General Administrative Regulations (EDGAR), in 34 CFR 74.51, 75.720, and 75.732). Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-4536 or email [email protected] and reference the OMB Control Number 1840-0762. Note: Please do not return the completed annual performance report to this address.

SECTION I – PROJECT IDENTIFICATION, CERTIFICATION, AND WARNING

1. Identification (all fields with an asterisk [*] are mandatory):

1. PR/Award Number: [will be prepopulated]

2. Name of Grantee Institution/Agency: [will be prepopulated]

3. Address: Campus:

Street:*

City:*

State:* [dropdown box] Zip:*

4. Name of Project Director:

Prefix: [dropdown box allowing choice among Mr., Mrs., Ms., Dr., Sister, Father]

First Name:* MI: Last Name:*

4. Telephone Number:* ext.:

Fax Number: ext.:

E-mail Address:*

6. Report Period: [will be prepopulated]

7. Type of Project: [will be prepopulated]

8. For UBMS projects only, please indicate whether project is *

 regional (i.e., serves at least two states) or

 non-regional (i.e., operates within a state or a locality).

8. Project Characteristics (to be completed by all UB and UBMS projects; not applicable to VUB) *

   1. Summer residential program (select one below)

____ Yes

____ No

____ Some participants are residential, others commute

2. Number of weeks of summer program (insert #) ______

3. Frequency of academic year contacts between project staff and participants (select only one)

____Weekly

____Twice a month

____Once a month

____Quarterly

____No face-to-face contact

____Other, ____________________________________________

8. Data Entry Person:

Prefix [dropdown box allowing choice among Mr., Mrs., Ms., Dr., Sister, Father]

First Name:* MI: Last Name:*

Telephone Number:* ext.:

If you would like to receive an e-mail confirmation upon receipt of your Annual Performance Report, please enter your e-mail address:

B. Certification

The Project Director and Certifying Official are required to sign and date Section I of the 2010–11 Annual Performance Report form to certify the accuracy and completeness of the information submitted electronically. After completing the entire report online, you will be able to print a copy of Section I, which will include signature lines for the project director and certifying official. Please print and fax SECTION I only to the U. S. Department of Education at 703-832-1360. Please use the Print button provided on the Submit page.

Please review the information in this section for accuracy and make needed changes before proceeding to the next section of the report form.

 I have verified the information in this section.

C. Warning

Any person who knowingly makes a false statement or misrepresentation on this report is subject to penalties which may include fines, imprisonment, or both, under the United States Criminal Code and 20 U.S.C. 1097.

Further federal funds or other benefits may be withheld under these programs unless this report is completed and filed as required by existing law (20 U.S.C. 1231a) and regulations (34 CFR 75.590 and 75.720).