Student Application Tom L. Wilson Blvd. Galesburg, IL (309)

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1 Application Due: Friday, April 14, 2017 Student Application 2400 Tom L. Wilson Blvd. Galesburg, IL (309) Find Us At:

2 INFORMATION ABOUT TRIO UPWARD BOUND 1. What is TRIO Upward Bound? A. TRIO Upward Bound (UB) is a college readiness program designed to assist high school students from low to modest income families and/or from families whose parents have not yet completed a four-year college degree B. TRIO Upward Bound assists high ability students to successfully develop the skills and motivation necessary to pursue and complete a college education. 2. Who may apply? Students may apply if they are in 8th, 9th or 10th grade and attend one of our target schools (Abingdon-Avon, Galesburg, Knoxville, ROWVA). Applicants must be: A. A U.S. citizen or permanent resident of the United States; B. A potential first-generation college student (parents have not earned a four year college degree); AND/OR C. Is considered income-eligible based on family s taxable income for Eligible students may also; A. Have a high risk for academic failure. 3. How much does it cost? A. All services and activities are provided FREE to participants and their parents/guardians. 4. What benefits does a student receive from participating in TRIO Upward Bound? A. TRIO UB offers academic year services of tutoring, workshops, and college access advising designed to enhance student academic skills and achievement. Upward Bound also offers weekly grade-specific academic sessions: *SENIORS: Weekly meetings with UB counselor, college visits, help with college applications and essays, scholarship applications, and financial aid assistance. *JUNIORS: Weekly meetings with UB counselor, study skills, college visits, SAT prep workshops, SAT waivers, informative financial aid workshops, career and college exploration *SOPHOMORES: Weekly meetings with UB counselor, study skills, college visits, financial aid informational meetings, career and college exploration *FRESHMAN: Weekly meetings with UB counselor, study skills, college visits, cultural activities B. TRIO UB offers 6 weeks of academic summer services. During this program students engage in: * Skill improvement in English, math, science, foreign language, and more. * Cultural, social, and recreational activities designed to foster personal growth, build leadership skills, and broaden student awareness and appreciation of the world. C. TRIO UB offers extra enrichment activities during the summer for specific grade levels: * Graduating Seniors are given the opportunity to complete up to two college courses for credit (Summer Bridge) * Rising seniors have the opportunity to complete a paid summer internship in a career field of their choice * Rising Juniors and Sophomores participate in the 6 week program focusing on English, math, science, and foreign language. * All summer participants have the opportunity to attend a week long Summer Trip.

3 THE COMPLETE APPLICATION PROCESS Step 1: Submit a student application. (If you are reading this...you have one!) TRIO Upward Bound recruits students from Abingdon-Avon, Galesburg, Knoxville and ROWVA area schools. The recruiting season is from February through April 14, TRIO UB provides applications during information sessions held in the schools. Step 2: Parents must submit an Eligibility form and return it as part of the Student Application. Step 3: Students and Parents must call and schedule an interview with TRIO UB staff to discuss their application and goals, as well as Upward Bound benefits, expectations and requirements. Step 4: Students must take the Stanford 10 online exam during one of our scheduled testing dates Step 5: Students and parent(s) are notified of admission decision. Upward Bound makes admission decisions in May. Newly admitted students begin TRIO UB participation in September. Step 6: New Student Orientation. If students are notified that they are accepted into our program, parent(s) and student meet with staff to discuss responsibilities and to complete new student paperwork. The orientation will be scheduled for a date in August. STUDENT APPLICATION CHECKLIST To make sure your student application is complete, check below to ensure you have all of the required components: Student Application and Eligibility form An essay titled Why I Want to Join TRIO Upward Bound. See the rest of this application for instructions on how to write this essay. Permission to Release Information form, signed by student and parent/guardian. See the rest of this application packet to find this form. One teacher recommendation from either your Science, English or Math teacher. These can be returned by the stu dent with this application (in a sealed envelope) OR the teachers may mail them directly to the UB offices. See the rest of this application packet to find these recommendations. Please also enclose the student s most recent report card or copy of transcripts, copy of parents 2016 Income Tax Return and a copy of the student s most recent PARCC scores. The Stanford 10 online exam will be offered on the following dates: March 23th, and 30th at 5:30 p.m.; April 6th and 13th at 5:30 p.m. and April 8th at 10:30 a.m. All exams will be administered in Building B, room B26 on the Carl Sandburg College Main Campus in Galesburg. Please view the enclosed map for reference. APPLICATION DUE DATE APRIL 14, 2017 * Return all of these materials to the Upward Bound office, located at Carl Sandburg College. Mailed applications may be sent to the following address: Carl Sandburg College Upward Bound, 2400 Tom L. Wilson Blvd., Galesburg, IL If you have any questions, please contact Sara Gross at or via , sgross@sandurg.edu.*

4 Personal Information Please Print Clearly Name First Middle Last Address School Cell Phone Home Phone Birthday / / Grade address Gender: Male Female Need for Program Services Please check the services you are most interested in receiving from Carl Sandburg College Upward Bound Program: Academic Tutoring College Field Trips ACT Prep College Prep Personal Counseling College Admissions Assistance Career Awareness Peer or Professional Mentoring Educational Planning Financial Assistance Cultural Field Trips Family Information With whom do you live? Both Parents One Parent Legal Guardian Foster Family Other (please explain) Mother s Name Father s Name Guardian s Name Daytime Phone No. Daytime Phone No. Daytime Phone No. Please list your brothers and/or sisters with their ages and current grade level: Name Age Grade Name Age Grade

5 Page 2 Academic Ability Please list your classes and the grade you received on your most recent report card Future Educational Plans Upward Bound is designed to help students achieve academically in school and enter postsecondary education. Please check the statement below that best describe your educational plans. I am undecided about my educational goals. I have no plans to continue my education after high school graduation. I plan to enter the military. I plan to attend a state supported college or university. I plan to attend a college or university out of state. I plan to attend a private school in Illinois Please list two career fields of interest The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education to raise college entrance and graduation rates in Knox County. This is a year-round educational experience. Upward Bound students are required to attend scheduled weekly workshops, participate in program travel, attend after-school tutoring and participate in the six-week summer program held on the Carl Sandburg College campus. My signature below indicates, to the best of my knowledge, the information provided on this form is true, complete and accurate. I hereby authorize the Carl Sandburg College staff to obtain copies of my child s academic and financial assistance records from the educational institution he or she is now attending and from educational institutions attended in the future. Student s Signature Date Parent/Guardian Signature Date For Office Use Only Application Interview App Forms Test Accepted Letter

6 Eligibility Form Student Information (Please print clearly) Name School Grade First MI Last U.S. Citizen: Yes No Ethnicity: (Mark all that applies) White African American Hispanic American Indian Hawaiian/Pacific Islander Parents Educational Completion Mother/Guardian Name: Please circle highest educational level completed Father/Guardian Name: Please circle highest educational level completed Grades Grades Certificate Program Certificate Program 2 Year Associate 4 Year Bachelor 2-Year Associate 4-Year Bachelor Income Documentation How many people live in your household (include children away at school) Please enter your taxable income from Your 2016 income tax form. Do not use Adjusted Gross Income for this report. If you filed Form 1040 use Line 43: $ If you filed Form 1040A use Line 27: $ If you filed Form 1040EZ use Line 6: $ If you did not file an income tax form, please indicate the amount shown on 2016 End of Year Statement: Wages, Salaries or Tips: Business or Farm Income: Social Security Benefits: Veteran s Benefits: Unemployment: $ $ $ $ $ My signature below indicates, to the best of my knowledge, the information provided on this form is true, complete and accurate. I hereby authorize the Carl Sandburg College staff to obtain copies of my child s academic and financial assistance records from the educational institution he or she is now attending and from educational institutions attended in the future. Parent or Guardian s Signature: Date:

7 Upward Bound Essay: Why I Want To Join Upward Bound Essay Instructions You must complete an essay as part of your application. This essay is your opportunity to explain: 1.) How TRIO Upward Bound will be helpful to you 2.) What you as a person will contribute to the program Please be specific. Your essay will be evaluated for content, organization, creativity, and attention to detail. You should also answer the following questions as you write: Why are you interested in TRIO Upward Bound, and what makes you a good fit? What obstacles may prevent you from getting into college? How can you overcome it? What are some of your ACADEMIC weaknesses? What are you doing to strengthen your skills in these areas? How would you balance Upward Bound with other activities you may be involved in such as sports, work, church and family? Who inspires you to achieve your academics? We ask that you please type your essay (you may attach a page printed from a computer word document) or write (print clearly in blue or black ink) using the designated space below and on the next page. Use additional paper if needed.

8 Essay continued

9 TRIO Upward Bound Carl Sandburg College Teacher Recommendation-English, Math or Science Dear Teacher, Student Name: is applying to the Carl Sandburg College TRIO Upward Bound program. TRIO Upward Bound is a college preparatory program for students who come from low-income families and/or are the first generation in their family to attend college. We provide students with intensive academic skill building and intensive college planning activities. Feedback on this student s performance and attitude in your class will help us to evaluate his/her potential to be successful in the Upward Bound program. We are looking for indicators that this student has a desire to do well and will take advantage of the TRIO Upward Bound services offered. Please mail to Upward Bound 2400 Tom L. Wilson Blvd. Galesburg, IL or fax to Course: School: Teacher Name: 1) Does the student complete assignments? Yes No 2) What grade do you estimate the student is earning at THIS time? 3) Estimate: a) Number of days absent: ; b) Number of days tardy: Teacher Questionnaire 1. In your opinion, how well has the student considered and prepared for a pre-college program, such as Upward Bound? 2. What do you consider the student s most outstanding academic strength? 3. What areas do you feel Upward Bound could assist this student academically? Motivation Basic Skills (Math, Reading) Leadership/Social Skills Goal Oriented Commitment Career Goals Other Signature: Date:

10 Parent Questionnaire Applicant: School: Parent/Guardian s Name: How did you learn about Upward Bound? If you had to choose things that your child needs to work on either academically, socially or emotionally what would you choose? In each area listed, identify a need that UB can help improve on. How would you describe your child? If students drop below a B in a core course they are required to attend study lab 4 hours a week until the next quarter grades come out. Your child tells you he or she doesn t need to go or doesn t want to go. How do you feel about that? What do you want to see your child accomplish in his or her life? What expectations do you have on Upward Bound regarding your child? Why do you want your child to be in Upward Bound? How much support can the program expect from you in regards to your stent s involvement in Upward Bound?

11 PERMISSION TO RELEASE INFORMATION 2400 Tom L. Wilson Blvd Galesburg, IL Office: Fax : Student Name (PRINT): Grade: Parent or Guardians Name (PRINT): Current School: High School attending or will be attending: Student and parent signatures on this form thereby gives the administrator(s), counselor(s), faculty or staff member(s) of the Jr. High School and High School of attendance of the below signed student permission to release current grades and/or test scores to representatives of the Upward Bound program of which the below signed student has applied. This release will be kept on file in the Upward Bound offices. Name of Jr. High School: Name of High School: Student s Printed Name: Student s Signature: Date: Parent s Printed Name: Parent s Signature: Date:

12 The College, an equal opportunity/affirmative action employer and educator, complies with applicable federal and state laws prohibiting discrimination, including Title VI, Title IX, Section 504, Age Discrimination Act, and Title II of the ADA. It is the policy of the College that no person, on the basis of race, color, religion, gender (sex), sexual orientation, national origin, age, disability, or veteran s status, or status in any group protected by application federal, state or local law shall be discriminated against in employment, in educational programs and activities, or in admissions. Title IX Coordinator Rick Eddy, ; ADA/Section 504 Coordinators: Rodney Blue, ; Jacob Runge,

13 Please Keep this sheet to write down your interview date and time Step 1: Submit a student application. TRIO Upward Bound recruits students from Abingdon-Avon, Galesburg, Knoxville and ROWVA area schools. The recruiting season is from February to April 14, TRIO UB provides applications during information sessions held in the schools. Step 2: Parents must submit an Eligibility form and return it as part of the Student Application. Step 3: Students and Parents must call and schedule an interview with TRIO UB staff to discuss their application and goals, as well as Upward Bound benefits, expectations and requirements. The interview must be done prior to the April 14th deadline. Step 4: Students must take the Stanford 10 exam during one of our scheduled testing dates. Testing must be done prior to the April 14th deadline. Step 5: Students and parent(s) are notified of admission decision. Upward Bound makes admission decisions in May. Newly admitted students begin TRIO UB participation in September. Step 6: New Student Orientation. If students are notified that they are accepted into our program, parent (s) and student meet with staff to discuss responsibilities and to complete new student paperwork. The orientation will be scheduled for a date in August. Interview You will need to set up an interview with a staff member of the Upward Bound program as soon as you submit your application. Please call Sara Gross at or at sgross@sandburg.edu Date of Interview: Time of Interview: Name of the Person doing the interview: Location of Interview: Building E, Student Success Center, Room # E-136 Stanford 10 Online Exam Dates All Upward Bound applicants must complete the Stanford 10 online exam. All exams will be given on the Carl Sandburg Main Campus in Galesburg (please view map on next page) in Building B, room # B26. Please choose one date to complete the test. March 23rd and 30th at 5:30 p.m. April 8th at 10:30 a.m.

14 Carl Sandburg College Main Campus, Galesburg

California State University, Los Angeles TRIO Upward Bound & Upward Bound Math/Science

California State University, Los Angeles TRIO Upward Bound & Upward Bound Math/Science Application must be completed in black or blue ink only. STUDENT INFORMATION Name: Social Security # - - First Middle Last Address: Apt.# Phone: ( ) City: State: Zip Code: Date of Birth: Place of Birth: