WHAT IS UPWARD BOUND PROGRAM? WHAT KIND OF SERVICES DOES UB PROVIDE? WHAT ARE THE ELIGIBILTY REQUIREMENTS? WHERE IS EDUCATIONAL TALENT SEARCH LOCATED?

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1 UPWARD BOUND PROGRAM ALABAMA STATE UNIVERSITY WHAT IS UPWARD BOUND PROGRAM? Upward Bound Program (UB) is a federally funded program offered through Alabama State University in partnership with Montgomery County, Lowndes County, Elmore County and Autauga County Schools. Our program aims to equip students and parents with accurate information on post-secondary and financial aid opportunities in order to empower student to attend college/ university of their choice after high school. WHAT KIND OF SERVICES DOES UB PROVIDE? Educational Talent Search is required to offer the following FREE services to students who qualify: Academic Tutoring Career Exploration Financial Aid Literacy College Entrance/Planning ACT/SAT Information University Campus Tours Academic Advising Summer Bridge Summer Camp WHAT ARE THE ELIGIBILTY REQUIREMENTS? The UB program is available to all middle, high school students who are U.S. citizens enrolled at our 7 participating schools at the time of application and have an academic need. You must also meet at least one or more of the following criteria: a) first generation student; b) income within federal guidelines; and c) have a documented disability. WHERE IS EDUCATIONAL TALENT SEARCH LOCATED? ALABAMA STATE UNIVERSITY ETS OFFICE IS LOCATED AT: Patterson Hall 326~ Montgomery, AL ~ Alabama State University

2 Application Check List Complete the attached UB Application with your parents. Attach proof of income Complete and sign Tax Verification Form Only if you did not file taxes the previous year Inform High School Counselor that you are applying to the program and request a copy of your most recent report card and SAT/ACT scores Submit Counselor Recommendation Form Submit Teacher Recommendation Form (Must be completed by a teacher in an academic area such as math, science, english, history or foreign languages.) Submit Application (Only completed applications with all required documentation attached will be reviewed.) *Upon application completion and review, you will receive a call, or letter via U.S. mail informing you about interview setup, acceptance or denial.

3 Upward Bound Program Application/Information Sheet STUDENT INFORMATION PLEASE PRINT LEGIBLY (Black or Blue Ink) NAME: ID#/SSN: Sex: Male Female (Last, First, Middle initial) Birth Date: MAILING ADDRESS: (Street Address, City, State, Zip) CURRENT PHONE #: ADDRESS: U.S. Citizen? YES NO CURRENT GPA: ACT/SAT HS GRADUATING YR: 20 Do you have a physical disability? YES NO ETHIC BACKGROUND American Indian/ Alaskan Native Asian Black/ African American Hispanic/ Latino Do you have a diagnosed disability? LEARNING PHYSICAL Native Hawaiian/ Other Pacific Islander White/ Caucasian Multi-racial Other (specify) CURRENT GRADE LEVEL 9 th 10 th 11 th 12 th CURRENT SCHOOL Jefferson Davis High Calhoun High Robert E. Lee High Park Crossing High Central High Sidney Lanier High Autagaville High College Interest: Career Interest: Armed Forces: Yes No Have you participated in the following programs? YES NO (If yes, check program) Educational Talent Search (ETS) Upward Bound(UB) Gear Up NEEDS ASSESSMENT Please check the areas you need assistance: Academic Academic Related Career Personal Reading Note taking Choosing a Major Time Management Math Attendance issues Choosing a Career Money Management English Test Taking Resume Writing Self-Esteem Science Scholarship Interviewing Skills Motivation Writing Financial Aid Job Search Skills Goal Setting INCOME ELIGIBILITY Sources of Household income Income (check all that apply) Employment Social Security Disability Pension Unemployment Welfare Veteran Benefits Total Household Income Range: $ 0 18,210 $ 18,210-$24,690 $24,690 - $31,170 $31,170 - $37,650 $37,650 - $44,130 $ 44,130- $ 50,610 $50,610 - $57,090 $57,090 - $63,570 $63,570 or more Number of People In your household Check here if you did not complete your taxes for the most current year

4 PARENT INFORMATION Student resides with: Both Parents Mother Only Father Only Legal Guardian Other: Mother/Guardian Name: Relationship: Occupation: Contact Phone: Father/Guardian Name: Relationship: Occupation: Contact Phone: Mother/Guardian High School Graduate? Yes No College Graduate? Yes No 2Yr Degree 4Yr Degree If yes, name of college or university: Father/Guardian High School Graduate? Yes No College Graduate? Yes No 2Yr Degree 4Yr Degree If yes, name of college or university: PARTICIPATION AGREEMENT & RELEASE OF INFORMATION I authorize Upward Bound to gather information concerning all my academic progress (standardized test scores, grade point average, grade report, earned credit, transcripts, tutoring, etc.) prior to my participation in UB. I understand that this information is used to help determine my eligibility for UB and I grant permission for UB to gather information for follow up whenever appropriate, including, but not limited to, progress to undergraduate institutions. I am aware that my eligibility will be reported to the U.S. Department of Education in accordance with the grant funding regulations. I certify that the information provided on this application is true and complete to the best of my knowledge. I also agree to provide documentation upon request to verify the information reported. (Student Initial) (Parent Initial) I hereby authorize the use of my photographic image in any and all publications, such as the monthly newsletter, newspaper articles, social media (Facebook, Instagram, Snapchat, Twitter, Remind101, ASU Buzz) and campus-wide notices. I authorize Alabama State University to use my name, photo or information about me in promotion of the college through radio, television or other materials. I understand that my picture could come from a digital image such as my file or from photos taken on various field trips and social events. (Student Initial) (Parent Initial) I am aware that personal information provided to the Upward Bound Program will be protected under the Federal Education Rights Privacy Act (FERPA) of No one will have access to the information unless they work with or for ETS, or are specifically authorized by me to see the information. (Student Initial) (Parent Initial) Student Signature: Date: Parent Signature: Date: FOR OFFICE USE ONLY Date Received: Application Reviewer: Blumen entry date: Notes: Eligibility: First Generation/Low Income First Generation Only Low Income Only Interview Date: Approved/ Accepted Not recommended/ Denied

5 UPWARD BOUND LETTER OF RECOMMENDATION (GUIDANCE COUNSELOR) Please complete this form and mail to: ASU Upward Bound P.O. Box 271 Montgomery, AL Applicant's Name: Expected Graduation Date: School Class Rank GPA: The student named above is applying for admission to the Upward Bound Program at Alabama State University. We would appreciate your recommendation as it is of considerable importance to us. This student, as of last semester, is: Behind At Ahead of grade level Which of the following best describes the student's current academic program: Vocational General College Prep Check one space for each category. 4=Superior; 3=Exceeds expectations; 2=Meets expectations; 1=Needs improvement; 0=Unacceptable Academic Evaluation Attendance Record Academic Skills Leadership Skills Motivation/Attitude Discipline/Behavior Please feel free to use the space provided below to explain any low ratings you have given to the applicant. Briefly outline this student's need for academic services. Please check mark in the category that applies. Does this student have the academic potential for postsecondary education? Yes No Would this student apply to college without the assistance of Upward Bound? Yes No Is this student in need of tutoring, counseling, and/or support services? Yes No RECOMMENDATION Yes, I recommend this student for the ASU Upward Bound Program. Please explain below No, I do not recommend this student for the ASU Upward Bound Program. Please explain below Counselor Print Name Signature Date

6 UPWARD BOUND LETTER OF RECOMMENDATION (TEACHER) Please complete this form and mail to: ASU Upward Bound P.O. Box 271 Montgomery, AL Applicant's Name: School: Teacher: Subject: Current Student Past Student The purpose of this evaluation form is to provide an objective and systematic way by which you may acknowledge your appraisal of this student. Please check the most appropriate performance rating. Performance Factor Quality of Work Accuracy, completeness, thoroughness, neatness Quantity of Work Completes required amount of work Dependability Follows instructions, attendance, punctuality Cooperativeness Initiative, constructive attitude, helpfulness Creativity Imagination, originality Adjustability Security, stability, adaptability Discipline Follows rules and regulations Sociability Self-esteem, peer relations, group acceptance Postsecondary Education Potential for success Excellent Above Average Average Below Average Poor Inferior Explain any low ratings: Keeping in mind the Upward Bound goal, which is to generate the skills and motivation essential to achieving success in postsecondary education please respond to the following: Student Strengths: Student Weaknesses: Would you classify this student as at risk? Yes No If yes, explain: What are some challenges this applicant faces in preparing for, getting admitted to, and succeeding in education after high school that Upward Bound could assist with? Signature Date