Fillable UB Student Application Packet (Kilgore College)

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UB Student Application Packet (Kilgore College)

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High School
New Student Application
Federal TRiO Program
Funded by the U.S. Department of Education
2
UB Parent Application (To Be Completed by Parent/Guardian):
Kilgore College/Upward Bound
1100 Br
oadway
Kilgore, TX 75662
Phone: 903.988.3760 Fax: 903.988.7425
Dear Parent/Guardian:
Your child has indicated an interest in the Upward Bound (UB) Project of Kilgore College. Upward Bound (UB) is a
free college preparatory program for high school students funded by the U.S. Department of Education and
sponsored locally by Kilgore College. UB is specifically designed to strengthen the academic skills of eligible high
school students to excel academically and pursue postsecondary degrees after high school graduation.
Year-round services provided by UB include:
• Tutorial services during the school year to strengthen academic skills and prepare student for success at the
college level:
• A 6-week summer instructional component that is designed to simulate a college-going experience that includes
daily coursework in Math, English, Foreign Language and Science as well as other related activities such as
field trips and special events;
• Academic advising from UB staff and individual assistance with the college admissions and financial aid
application process during the academic school year.
In order to comply with federal regulations, all UB participants must meet the following criteria:
• Commit to attending college the fall semester after high school graduation;
• Demonstrate academic need
• Qualify as Low Income and/or Potential First Generation College Graduate (neither parent has
received a 4-year degree);
• Commit to remain active in all UB activities until high school graduation
Please complete this application and return with your child’s Student Application to the address or fax number
listed above. You may also return your completed application to your child’s school counselor. All completed
applications will be reviewed and eligible applicants contacted within 14 days for a Student & Parent Interview with
program staff.
Thank you for your interest in the Upward Bound Project. Please call the UB project director at 903.988.3760 if you
have any questions or need additional assistance.
Sincerely,
Jude Dubois
Jude Dubois
Director, Upward Bound
3
HISTORY: The history of TRIO is progressive. It began with Upward Bound, which emerged
out of the Economic Opportunity Act of 1964 in response to the administration's War on
Poverty. In 1965, Talent Search, the second outreach program, was created as part of the
Higher Education Act. In 1968, Student Support Services, which was originally known as
Special Services for Disadvantaged Students, was authorized by the Higher Education
Amendments and became the third in a series of educational opportunity programs. By the
late 1960's, the term "TRIO" was coined to describe these federal programs.
Over the years, the TRIO Programs have been expanded and improved to provide a wider
range of services and to reach more students who need assistance. The Higher Education
Amendments of 1972 added the fourth program to the TRIO group by authorizing the
Educational Opportunity Centers. The 1976 Education Amendments authorized the Training
Program for Federal TRIO Programs, initially known as the Training Program for Special
Programs Staff and Leadership Personnel. Amendments in 1986 added the sixth program, the
Ronald E. McNair Post baccalaureate Achievement Program. Additionally, in 1990, the
Department created the Upward Bound Math/Science program to address the need for
specific instruction in the fields of math and science. The Upward Bound Math/Science
program is administered under the same regulations as the regular Upward Bound program,
but it must be applied for separately. Finally, the Omnibus Consolidated Appropriations Act of
2001 amended the Student Support Services (SSS) program to permit the use of program
funds for direct financial assistance (Grant Aid) for current SSS participants who are receiving
Federal Pell Grants.
PURPOSE: Upward Bound provides fundamental support to participants in their preparation
for college entrance. The program provides opportunities for participants to succeed in their
precollege performance and ultimately in their higher education pursuits. Upward Bound
serves high school students from low-income families and high school students from families
in which neither parent holds a bachelor's degree or either first generation student (neither
parent holds a bachelor’s degree) or low income families. The goal of Upward Bound is to
increase the rate at which participants complete secondary education and enroll in and
graduate from institutions of postsecondary education.
PROGRAM SERVICES: All Upward Bound projects MUST provide instruction in math,
laboratory science, composition, literature, and foreign language. Other services include:
4
• Information on the full range of Federal Student Financial Aid programs and benefits
• Guidance and assistance on secondary school reentry, alternative education programs,
or entry into general educational development programs or postsecondary education
• Academic, Personal, College and Career Counseling
• College, Cultural, and Business Tours
• ACT, SAT, and College Application Fee Waivers
• Assistance in Career Exploration
• Academic Tutoring provided at target schools or host institution (Kilgore College)
• Parent Involvement Activities
• College Selection/Planning/Admissions
• Standardized Test Preparation
• Six Week Summer Academic Program
• Academic Enrichment Saturday’s (once a month)
• Transportation provided for UB participants to Saturday events & Summer Academic
Program for LHS and PTHS students
• Transportation provided for UB participants from KC to college, cultural, and business
tours
PARTICIPATING AREA SCHOOLS:
KILGORE HIGH SCHOOL
LONGVIEW HIGH SCHOOL
PINE TREE HIGH SCHOOL
TOTAL NUMBER OF PARTICIPANTS: 50
QUESTIONS? Contact us!
Jude Dubois, Director, KC Upward Bound
903-988-3760 or jdubois@kilgore.edu
Halen Dorsey, Project Advisor, KC Upward Bound
903-988-7427 or hdorsey@kilgore.edu
Fa
x: 903-988-7425
Kathryn Parker, Project Advisor, KC Upward Bound
903-988-3765 or kparker@kilgore.edu
Fax: 903-988-7425
For more information about TRIO: Upward Bound programs
http://www2.ed.gov/programs/trioupbound/index.html
5
Kilgore College Upward Bound Program
Application Checklist
In addition to the Student Application, you must also turn in the following documents and forms listed in the
checklist below. Please turn in your completed application packet using a folder to ensure that all of your
paperwork is located in one place. Completed application packets can be left in your High School’s
College/Career Counseling Center; there will be an inbox for Kilgore College Upward Bound located there.
Upward Bound staff will check the box for completed application packets throughout the school term.
In order for your application to be reviewed for consideration of acceptance into the Kilgore College Upward
Bound Program, you must submit all of the following forms/documents at your earliest convenience. If you have
questions or concerns regarding any of the forms, or wish to inquire about the status of your application, please
do not hesitate to contact our office. Our contact information is provided below. Students must have a
minimum of a 2.5 GPA or higher.
PLEASE
PUT YOUR INITIALS NEXT TO EACH ITEM AS YOU COLLECT THEM
TO ENSURE THAT YOU HAVE INCLUDED ALL APPLICATION MATERIALS BEFORE SUBMITTING.
____ Student Application completed
____ Parent Release Forms completed
____ Copy of most recent signed 1040 income tax return
____ Copy of most recent report card
____ Copy of most recent transcript (if current 9
th
grader, include 8
th
grade transcript)
____ Copy of STAAR scores if you have taken either test
____ Copy of student’s birth certificate
____ Copy of student’s social security card
____ Counselor Recommendation #1 submitted (counselors may also mail or fax to us)
____ Teacher Recommendation #2 submitted (teachers may also mail or fax to us)
Contact Information for Kilgore College Upward Bound Staff
Director: Jude Dubois 903.988.3760 jdubois@kilgore.edu
Office Location: 214 Student Support Building (Fax) 903.988.7425
Upward Bound, 1100 Broadway, Kilgore, TX 75662
6
Please note that all applications are accepted for review regardless of race, color, national
origin, religion, gender or disability (U.S. Dept. of Education -GEPA Section 427).
Upward Bound Program Application
DIRE
CTIONS:
• Print clearly in ink.
• Be sure to answer all questions.
• Remember your parent/guardian’s signature is required.
• Mail or fax your complete application to: Kilgore College/Upward Bound
1100 Broadway
Kilgore, TX 75662
Phone: 903.988.3760 Fax: 903.988.7425
• You may also submit your complete application directly to your school counselor.
PART I - STUDENT APPLICANT INFORMATION
Date:
Name:
Social Security #: School ID #:
Email Address:
High School Currently Attending:
Current Grade Level: T-Shirt Size:
Mailing Address: Street and Apt. No.
City
Zip
Home Phone Number:
Alternative Phone Number:
Date of Birth:
Age:
Gender:
__________Male ___________Female
Citizenship:
Are you a U.S. Citizen?
�
YES
�
NO If NO – Are you a Permanent Resident?
�
YES
�
NO
r: ________________________
Ethnic Background:
____ African American or Black ____ American Indian ____ Asian/Pacific Islander
____ Hispanic ____ White ____ More than one race _____________________
____ Other ___________________________________________________________
blac
Who do you live with?
____Mother & Father ____ Father ____ Mother ____ Guardian ___ Other
Name of Guardian if you do not live with one of your parents: __________________________________________
7
What language is spoken at home?
____ English ____ Spanish ____ Other______________________
What are you favorite school subjects?
What grades do you usually get?
What college or university do you plan to attend?
� Undecided
What do you plan on majoring in?
� Undecided
What grades do you usually get?
What kind of career or job would you like to have?
� Undeci
ded
� Undecided
How did you find out about Upward Bound?
What type of degree do you plan to obtain? You can check more than one.
_____ High School Diploma _____ Vocational or Technical School Degree ______ Two Year/Associate Degree
_____ 4 Year College Degree _____ Masters Degree ______ Doctoral Degree
List any extracurricular activities are you involved in?
Do you work or plan to work this school year and/or this summer? ____Yes ____ No
If Yes, when? __________
___________________________ Where? ________________________________________________
How many hours a week? ________
_____
PLEASE ATTACH A COPY OF YOUR MOST RECENT REPORT CARD TO THIS APPLICATION.
RELE
ASE OF SCHOOL RECORDS
I authorize the Upward Bound Program of Kilgore College to access Skyward and/or receive copies of my academic
transcripts, grade reports, report cards, STAAR scores, and any other academic information and test results necessary to
complete the program’s application process.
Student’s Signature: Parent(s)/Guardian(s) Signature:
Student’s Name: ______________________________________ Social Security #: _______________________________
School: _____________________________________________ Current Grade: ____________________
The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, and the Texas Public Information Act, Texas Government Code §552.001 et seq., are
respectively federal and state laws providing for the review and disclosure of student educational records. The University and Outreach Programs-TRIO and GEAR
UP will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent
of the student, except as authorized by FERPA.
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8
Personal Essay
The personal essay is an important part of the selection process. Be sure to complete the essay in your handwriting.
In a 250 or more word essay discuss ONE of the following topics: 1) Events and people in your life that have influenced you
in your educational and professional goals and aspirations; OR 2) Your purpose in applying to Upward Bound Program: what
you believe you will achieve from the experience, and the contributions you can make to the program; OR 3) Your most
impressive accomplishment and how it has impacted your life. Please attach additional pages if necessary.
Please give the attached Recommendation Forms to at least two: teacher or counselor at your high school. Remind your
teacher(s)/counselor(s) to mail or fax these forms to our office as soon as possible. They can also return completed
Recommendation Forms to you in a sealed envelope to submit with this application.
9
PART II –
RECOMMENDATION FORMS (To be completed by a Teacher)
Kilgore College/Upward Bound
1100 Broadway
Kilgore, TX 75662
Phone: 903.988.3760 Fax: 903.988.7425
Teacher Recommendation Form
Dear Teacher:
The student listed below is applying for admission into the Upward Bound (UB) Project of Ki
lgore College. Your assessment of the
student’s conduct, character and academic need for program services is an integral element in the admission process. Please give us
your honest assessment of this student’s desire and ability to learn. Please mail the completed Recommendation Form to the above
address or fax. You may also return the completed Recommendation Form to the student in a sealed envelope to submit with his/her
completed student application. Should you have any questions or concerns, please feel free to contact the UB Director the number listed
above. The time and effort you have taken to complete this form is sincerely appreciated.
Student’s Name
Grade Level School __________________________
Class/Course Subject: _______________________________ Current Class/Course Grade
Please place an "x" in the appropriate column for each characteristic listed below:
STUDENT CHARACTERISTICS
EXCELLENT
AVERAGE
FAIR
POOR
DEMONSTRATES RESPONSIBLE BEHAVIOR/CONDUCT IN CLASS
WILLINGLY PARTICIPATES IN CLASS
IS DEPENDABLE AND RELIABLE
ABILITY TO COOPERATE WITH SCHOOL STAFF/FOLLOW INSTRUCTIONS
COMPLETES ASSIGNED WORK ON TIME
STUDY SKILLS/HABITS
ANALYTICAL THINKING SKILLS
MATURITY/INTEGRITY/AND RELATES WELL TO PEERS
HAS GOOD ATTENDANCE/PUNCTUALITY RECORD
EXPRESSES INTEREST IN ACADEMIC ENDEAVORS
WILL BE SUCCESSFUL IN COLLEGE ENDEAVORS
Please provide comments on motivation, behavior, personality, strengths or weaknesses that you feel are pertinent to the student’s
performance in Upward Bound. Additional comments may be written on the back.
Teacher’s Printed Name & Title School Telephone Number
Teacher’s Signature Date
Th
e Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, and the Texas Public Information Act, Texas Government Code §552.001 et seq., are
respectively federal and state laws providing for the review and disclosure of student educational records. The University and Outreach Programs-TRIO and GEAR
UP will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent
of the student, except as authorized by FERPA.
10
PART II – RECOMMENDATION FORMS (To be completed by Teacher)
Kilgore College/Upward Bound
1100 Broadway
Kilgore, TX 75662
Phone: 903.988.3760 Fax: 903.988.7425
Teacher Recommendation Form
Dear Counselor:
The student listed below is applying for admission into the Upward Bound (UB) Project of Kil
gore College. Your assessment of the
student’s conduct, character and academic need for program services is an integral element in the admission process. Please give us
your honest assessment of this student’s desire and ability to learn. Please mail the completed Recommendation Form to the above
address or fax. You may also return the completed Recommendation Form to the student in a sealed envelope to submit with his/her
completed student application. Should you have any questions or concerns, please feel free to contact the UB Director at the number
listed above. The time and effort you have taken to complete this form is sincerely appreciated.
Student’s Name Grade Level School __________________________
Class/Course Subject: _________________________________ Current Class/Course Grade
Please place an "x" in the appropriate column for each characteristic listed below:
STUDENT CHARACTERISTICS
EXCELLENT
AVERAGE
FAIR
POOR
DEMONSTRATES RESPONSIBLE BEHAVIOR/CONDUCT IN CLASS
WILLINGLY PARTICIPATES IN CLASS
IS DEPENDABLE AND RELIABLE
ABILITY TO COOPERATE WITH SCHOOL STAFF/FOLLOW INSTRUCTIONS
COMPLETES ASSIGNED WORK ON TIME
STUDY SKILLS/HABITS
ANALYTICAL THINKING SKILLS
MATURITY/INTEGRITY/AND RELATES WELL TO PEERS
HAS GOOD ATTENDANCE/PUNCTUALITY RECORD
EXPRESSES INTEREST IN ACADEMIC ENDEAVORS
WILL BE SUCCESSFUL IN COLLEGE ENDEAVORS
Please provide comments on motivation, behavior, personality, strengths or weaknesses that you feel are pertinent to the student’s
performance in Upward Bound. Additional comments may be written on the back.
The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, and the Texas Public Information Act, Texas Government Code §552.001 et seq., are
respectively federal and state laws providing for the review and disclosure of student educational records. The University and Outreach Programs-TRIO and GEAR
UP will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent
of the student, except as authorized by FERPA.
11
PART III - Student Needs Assessment (To be completed by student):
Please check all the following UB services and activities that you need or would be interested in receiving?
ACADEMIC SERVICES & ACTIVITIES: You can check more than one.
____ Academic Advising and Report Card Checks
____ Study & Test Taking Skills
____ STAAR Test Preparation & Tutorials in: Math ___ English ___ Both ___
____ Tutoring or Homework Assistance with the following core high school courses (You can check more than one):
___Math ___English ___Science ___Foreign Language
____ College Preparatory Instruction in English, Math, Science, and Foreign Language
____ College Adjustment and Orientation Activities
____ Early College Enrollment Program Information
____ Other ______________________________________________________________________________________
COLLEGE ADMISSIONS & FINANCIAL AID SERVICES & ACTIVITIES: You can check more than one.
____ College Awareness and Exploration
____ College Field Trips
____ Financial Aid Awareness and Scholarship Information
____ College Admissions and Testing Fees
____ Individualized Assistance with College Admissions & Financial Aid Application Process
____ Other ______________________________________________________________________________________
OTHER SUPPORTIVE SERVICES & ACTIVITIES: You can check more than one.
____ Goal-Setting and/or Self-Esteem Building
____ Leadership & Citizenship Skills
____ Career Awareness and Exploration
____ Career Field Trips
____ Cultural Awareness
____ Community Service Opportunities
____ Other ____________________________________________________________________________________
__
12
PART IV-UB Parent Application (To Be Completed by Parent/Guardian):
Student’s Name:
Current School & Grade Level:
Mother’s Name:
Father’s Name:
Mother’s Address:
Father’s Address:
Mother’s Home Phone Number:
Father’s Home Phone Number:
Mother’s Cell Phone Number:
Father’s Cell Phone Number:
Mother’s Work Number:
Father’s Work Number:
Has either parent received a 4-year degree from a college or university?
_______Yes ________No
I certify that the information provided on this form is true and complete to the best of my knowledge.
_____________________________________________ __________
Parent’s Signature Date
Income Information:
Please attach a SIGNED copy of your most recent 1040 Income Tax Form in order to verify annual taxable income. If you did not file 1040
income tax please compete page 14.
.
RELEASE OF SCHOOL RECORDS
I authorize the Upward Bound Program of Kilgore College to access Skyward and/or receive copies of my student’s
academic transcripts, grade reports, report cards, STAAR scores, and any other academic information and test results
necessary to complete the program’s application process.
__
___________________________________________
Parent’s Signature
Student’s Name: ________________________________________ Social Security #: _______________________________
School: _____________________________________________
The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, and the Texas Public Information Act, Texas Government Code §552.001 et seq., are
respectively federal and state laws providing for the review and disclosure of student educational records. The University and Outreach Programs-TRIO and GEAR
UP will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent
of the student, except as authorized by FERPA.
13
Kilgore College Upward Bound Program
PART V-UB Student/Parent Contract of Participation
I, ________
________________________________, understand that if these rules are not followed, I will be dismissed from the Kilgore
College Upward Bound Program.
1. I have read the Upward Bound Handbook and agree to abide by all the guidelines and regulations outlined.
2. I will show respect toward all Upward Bound Program staff and fellow UB students, and I will take responsibility for my actions.
3. Students are expected to attend and complete all required Academic Saturday classes, assigned tutoring sessions, and activities
(cultural, educational, community service, social) hosted by UB throughout the academic year and summer.
4. I will ensure that my parent/guardian provide written documentation to the Director of the program if I cannot attend an Upward
Bound sponsored event. All scheduling conflicts must be provided in writing to UB staff at the first UB event of each academic
semester or summer.
5. I will work toward maintaining at least a 2.5 grade point average in all of my high school courses/classes.
6. I w
ill attend the six-week mandatory summer academic enrichment program and manage my summer plans around the summer
program.
7. There will be no smoking, illegal drug use, or consumption of alcoholic beverages at any time. UB staff will notify both
parents/guardians and the proper authorities if a student is caught with any of these items in their possession.
8. UB Dress Code will be followed at all times
(Short shorts, short skirts, or short dresses; Backless shirts or dresses; Tank tops, halter tops,
or low cut shirts; Baseball caps, hats, or sunglasses while inside a facility or during an activity, unless approved by UB staff; Sagging or visible
layering of shorts under pants; Any clothing with offensive language or alcohol/drug advertisements; Clothing with holes that show skin, see-through
clothing, or spandex clothing.)
Students must wear the standard issued Upward Bound tee shirt to all activities.
9. NO racial slurs, discriminatory name-calling, or bullying will be tolerated. Absolutely no fighting will be allowed.
10. I
understand that I may not leave any UB events at any time unless I have received prior permission from the Director.
11. Al
l students must return notebooks, textbooks, and other supplies that are used for classes.
12. I w
ill follow all policies and expectations of the Upward Bound Program as outlined in the Student Handbook.
13. I will develop my academic skills so that I will graduate from high school and college.
14. I am committed
to attending college the fall semester after high school graduation.
St
udent Signature: ___________________________________________________ Date: _____________________________
Par
ent/Guardian Signature: ____________________________________________ Date: _____________________________
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UB Student Application Packet (Kilgore College)

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Completed 6 October 2020

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