DUE DATE: November, 2017 Turn in completed application(s) to the TRIO Upward Bound mailbox in the Main Office. STUDENT APPLICATION

Transcription

1 DUE DATE: November, 2017 Turn in completed application(s) to the TRIO Upward Bound mailbox in the Main Office. STUDENT APPLICATION PREPARING FUTURE COLLEGE GRADUATES SINCE Education Sciences Bldg 40 Education Sciences Building 56 East River Road Minneapolis, MN Phone: (612) Website: Facebook:

2 What is TRIO Upward Bound, University of Minnesota? TRIO Upward Bound (TRIO UB) is a college readiness program that helps students from low to modest income families and/or students from families whose parents have not yet completed a college degree. TRIO Upward Bound helps students build the skills and motivation necessary to pursue and complete a college education. Who may apply? Attend one of our target Minneapolis high schools: Edison, North, South, or Patrick Henry; Are in the 9 th or 10 th grade; Have a current grade point average of 2.5 or above; Be a first-generation college student; Are a U.S. citizen or permanent resident of the United States; and/or Are in an income-eligible family (students qualify for free or reduced lunch). What about cost? About TRIO Upward Bound Services and activities are FREE to participants and their parents/guardians. Participants can earn a small monthly performance stipend (money). What services do students receive from TRIO UB? We provide year-round, holistic, intensive and long term academic and college preparation. Services include: Academic Year Program October - May Weekly after school classes Tutoring (Monday-Thursday) Financial aid & literacy workshops College visits & field trips Leadership development opportunities Educational workshops for parents/families Scholarship opportunities ACT preparation Summer Program June - August 5 weeks of academic classes Monday- Friday 3 weeks of living in the dorms at the University of Minnesota Twin Cities Experimental & cultural activities Community service opportunities 3-day Regional College Tour 5-day wilderness retreat 6-week Bridge program for recent TRIO UB graduates; an opportunity to earn college credit Application Checklist & Timeline Application Checklist & Timeline Student Application o Copy of Social Security Card & Medical Card Permission to Release Information Form Teacher Recommendation Form Parent Application Turn in completed application(s) to the TRIO Upward Bound mailbox in the Main Office. October November December January Applications Open Applications Due Family Information Meetings Student are selected Letters are sent home New Student Orientation Program Begins

3 Student Application Please use a BLUE or BLACK pen. DO NOT USE PENCIL! Part One: Applicant Contact Info & Demographics First Name: Middle Initial: Last Name: Address: _ Street Address Apartment/Building Number (if any) City: State: Zip Code: Home Phone: Cell Phone: Sex: Male Female Other: Social Security Number: / / Please attach a copy of your Social Security Card As a federally-funded program, we must document your Social Security Number. If you have questions for concerns, please contact TRIO Upward Bound University of Minnesota Twin Cities at or ubtrio@umn.edu. Date of Birth: / / Month Day Year Age: Are you a U.S. Citizen? Yes No If No, what country were you born in? Are you a Permanent Resident or Resident Alien? Yes No If Yes, please attach copy of your Permanent Resident /Resident Alien card (both sides) Ethnicity/Race: Check all that apply to you. Native Hawaiian / Pacific Islander Hispanic / Latino African American / Black Caucasian / White Bi-Racial/Multi-Race American Indian or Alaskan Asian American / Asian Other: Part Two: Family & Educational Background What languages do you speak and/or spoken in your home? Primary: Who do you live with? Check all that apply. Secondary: One parent Alone Non-relative Guardian: Both parents Spouse Relative Guardian: Step Parent(s) Group Home Other: Foster Parent(s) Foster Home: Name of Parent/Guardian 1: Phone Number: Name of Parent/Guardian 2: Phone Number:

4 What Middle School did you attend? Middle School GPA: What High School do you currently attend? (Circle one) Edison Patrick Henry North South High School MPS Student ID #: High School GPA: Current Grade: (Circle one) Name of High School Counselor: Are you enrolled in an ESL or ELL class? Yes No If yes, please list: Do you have any disabilities (physical, mental, learning, etc.)? Yes No If yes, please list: Part Three: Extra-Curricular & After School Commitments What extra-curricular activities are you currently involved in or plan to join? Check all that apply. Sports: Day(s) of the week? Music: Day(s) of the week? Clubs: Day(s) of the week? Faith/Religious: Day(s) of the week? Other: Do you have a job? Yes No If yes, what is the name of your employer? What days do you typically work? How many hours a week? How will you balance TRIO Upward Bound with your afterschool activities, work, and home life? Have you ever been in a TRIO Upward Bound, ETS, or GEAR UP? Yes No If yes, where and when? How did you hear about TRIO Upward Bound? School Counselor or Teacher: Community Organization: Parent/Guardian or Family Member: Current Student at TRIO Upward Bound: TRIO Upward Bound Staff: Other:

5 Part Four: Student Questionnaire & Essays List two non-academic (not school related) facts you want TRIO Upward Bound staff to know about you: Choose one word to describe yourself: Why did you choose that word? If you could meet anybody, fictional or non-fictional, dead or alive, who would it be and why? TRIO Upward Bound offers a variety of services to increase your knowledge and skills. Which of the following interests you? Check all that apply. Communicate better with my family Learn to express emotions Set and accomplish goals Discover my strengths and weaknesses Develop public speaking skills Communicate my feelings Learn to be less shy and/or make new friends Learn how to manage stress Discover possible careers Learn how to make decisions Develop leadership skills Experience cultural and social events Participate in recreational activities Improve study skills Improve test taking skills Community service opportunities Learn how to resolve conflicts Learn advocacy skills Other: Can you commit to participating in TRIO Upward Bound Summer Program including: 1. Five weeks of summer academic enrichment classes Monday Friday, June to July, 2. Stay overnight in the residence halls at the University of Minnesota Twin Cities for three weeks, AND 3. Participate in college tours and service trips? Yes No

6 Please answer each essay question thoroughly with examples that reflect your academic and social interests and goals. Each answer should be in paragraph form. Why do you want to join TRIO Upward Bound? How will TRIO Upward Bound help you? In 10 years, where do you see yourself? Why do you want to go to college? How will you get there? Who inspires you to achieve more in your academics and what is his/her message to you? Student Signature Date

7 TRIO Upward Bound University of Minnesota Twin Cities College of Education + Human Development 40 Education Sciences Building 56 East River Road, Minneapolis, MN Office: PERMISSION TO RELEASE INFORMATION Student Name (PRINT) Birth Date: Grade Parent or Guardian Name (PRINT) District: Minneapolis Public Schools Student ID #: School: E PH N S Minneapolis Public Schools has my permission to release educational data (including transcripts, grades, test scores, attendance records, IEP/504 plans, disciplinary action write ups, Naviance records, etc.) to the University of Minnesota, College of Education and Human Development (CEHD), TRIO Upward Bound Program (TRIO UB). This release is valid from the date of signature until my student graduates high school. I understand that this release may be revoked at any time in writing. I understand that this information will be used in determining admission to the program and in planning my student s academic programming once admitted to the TRIO Upward Bound program at the University of Minnesota. TRIO Upward Bound will use the educational data for the following reasons: 1. TRIO Upward Bound must report students progress to the U.S. Department of Education to demonstrate program effectiveness. 2. Upon request, TRIO Upward Bound will report students progress to the Minneapolis Public Schools to assist counselors and teachers to serve TRIO Upward Bound students better. 3. To connect TRIO Upward Bound students to scholarship agencies, youth leadership, employment, educational and other programs. 4. To obtain college admission and financial aid application fee waivers. 5. To discuss admission and financial aid opportunities with educational professionals. 6. Permission to participate in TRIO Upward Bound approved research projects designed to improve services and identify areas where TRIO Upward Bound students need assistance. We (student and parent/guardian) have read the above information and understand that this consent takes effect on the date of signature. Student Signature: Date: Parent/Guardian Signature: Date: Students under the age of 18 must have a parent or guardian signature.

8

9 TRIO Upward Bound University of Minnesota Twin Cities College of Education + Human Development 40 Education Sciences Building 56 East River Road, Minneapolis, MN Office: TEACHER RECOMMENDATION FORM English, Math, or Science Class Student Name: is applying to TRIO Upward Bound (TRIO UB), College of Education and Human Development, University of Minnesota. TRIO UB is an academic and residential 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 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 TRIO Upward Bound. We are looking for indicators that this student has a desire to do well and will take advantage of TRIO Upward Bound services. High School: (Circle one) Edison Patrick Henry North South Teacher Name: Course: Can we contact you via if needed? Yes No 1. Does the student complete assignments on time? Yes No Please explain, if needed: 2. What grade do you estimate the student to be earning at THIS time? 3. Please estimate: Number of days tardy: Number of days absent: 4. Check any of the following attitude and behavior characteristics to describe this student: Assertive Hard Worker Positive Attitude Attentive Independent Worker Helpful Motivated Participates in class Utilizes resources Responds well to intervention Works well with peers Actively listens in class Demonstrates leadership skills Overly Social Disruptive Needs constant supervision Constantly tardy/late Distracted Negative attitude Talks back to teacher/peers Other: 5. Students quality of work in your class is: (Circle one) Student is Organized OR Disorganized Class assignments are Thorough OR Incomplete Student work is Below Standard OR Standard OR Above Standard Student Challenges self OR Does minimum Other comments: Thank you! We appreciate you taking the time to fill this out. Please return form to the student OR put it in the TRIO Upward Bound mailbox in the Main Office. Please sign below to confirm you have completed this form. Teacher Signature Date