OMB Approval No.: 1840-0762

 Expiration Date: [TBD]

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

Annual Performance Report

Program Year 2012–13

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 8.5 

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 

ICDocketMgr@ed.gov and reference the OMB Control Number 1840-0762. Note: Please do not return the completed annual 

performance report to this address. 

SECTION I, Part 1 – PROJECT IDENTIFICATION, CERTIFICATION, AND 

WARNING

A. 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:*

5. 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).

9. *Project Characteristics 

a. Summer residential program (select one below)

____ Yes ____ No

____ Some participants are residential, others commute

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

c. 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: __________________________________

10. Data Entry Person:

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, Part 1 of the 

2012–13 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, Part 1, which will include signature lines for the project director and 

certifying official. Please print and fax SECTION I, PART 1 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)
SECTION I, Part 2: Competitive Preference Priorities (If Applicable)

The 2012 UB and UBMS grant competitions established three competitive preference priorities 

concerning persistently lowest-achieving schools, data-based decision-making, and improvements 

in productivity. The Department will derive data for the first competitive preference, concerning 

projects’ service to persistently lowest-achieving schools, from the “Target School—NCES 

Identification Number” field (#26) in Section II, which provides identifying information on the 

target school attended by each participant. Below, please indicate whether your project addressed 

the remaining two competitive preference priorities. For each priority addressed, please complete 

the text boxes with concise information about implementation. 

Competitive Preference Priority #2: The Secretary encourages applicants to work with 

appropriate State agencies to use data from State longitudinal data systems or to obtain 

data from reliable third-party sources when providing information on the implementation 

of their UB/UBMS projects and their participants’ outcomes.

1A. Not applicable □

1B. Yes □ 

If “Yes,” indicate below which data systems your project utilized.

State longitudinal data systems Third-party data systems

Competitive Preference Priority #3: The Secretary encourages applicants to design 

projects that serve the same or increased number of students at a lower cost per 

participant while improving or keeping steady student outcomes. 

3A. Not applicable □

3B. Yes □

If “Yes”, indicate below how your project achieved this productivity by increasing 

efficiency in the use of time, staff, money or other resources.

Resource/Measure used with 

increased efficiency

Improved Outcome