Application. Dear Student:

Transcription

1 Application Dear Student: We are pleased you are taking this very important step in your desire to attend college. Funded by the US Department of Education, Upward Bound is an academic and college preparatory program designed to help students graduate from high school and enroll in the college or university of their choice. Students participating in Upward Bound are sometimes the first in their family to go to college. We understand how scary and hard getting to college is. We are here to help. Upward Bound offers a variety of FREE services including but not limited to: Saturday and Weekly afterschool tutoring/enrichment College and cultural events/trips Career exploration Assistance in preparing for standardized tests (TAKS, STAAR, ACT, SAT, etc.) A six week summer program at Texas State University Complete assistance with the college admission and financial aid processes Opportunities to earn stipends for participating in UB events College access workshops for parents If you want to be part of a program that: Helps you keep your grades up from your FRESHMAN to SENIOR year Helps you stay focused on going to college Gives you a REAL college experience before you get there Develops your leadership skills Upward Bound is the right program for you. If you are interested in applying, complete the attached application. Make sure you provide us with ALL of the requested documentation. An incomplete application cannot be considered. We have included an application checklist to assist you. Once we have reviewed your completed application, an Upward Bound staff member will contact both you and your parent for a brief interview. Upward Bound will then notify you of your acceptance into the program. If you have any questions about completing the application or Upward Bound, please call or us at upwardbound@txstate.edu. We look forward to working with you! The Texas State Upward Bound Team UPWARD BOUND 601 University Drive Long House San Marcos, Texas phone: fax:

2 Upward Bound Program Application STUDENT INFORMATION Name: High School: Grade Level: Social Security#: School ID#: Student Mailing Address: City: State: Zip: Home Phone #: Student Cell #: Date of Birth: Age: Gender: Male Female T-shirt size: Small Medium Large XL 2XL 3XL Citizenship: Yes No If no, are you a permanent resident? Yes No Resident # Ethnic Background: African American/Black American Indian/Alaskan Native White Hispanic Asian Native Hawaiian/Islander (San Marcos and Seguin only) Are you a participant in Rural Talent Search? Yes No Do you know what RTS is? Yes No PARENT INFORMATION Parent/Guardian 1: Parent/Guardian 2: Relationship to Student: Relationship to Student: Address: Address: Home Phone #: Home Phone #: Cell Phone #: Cell Phone #: Work #: Work #: Has either parent received a 4- year degree from a college or university? Yes No If yes, which parent: Father Mother Which institution? What is the primary language spoken in your home? English Spanish Other Who does the student reside with? Father Mother Guardian Other Name of Guardian (if you do not live with one of your parents) Revised 1/14/13 Page 1

3 STUDENT NEEDS ASSESSMENT 1. Do you have below an 85 on your most recent report card in Math, English or Science? 2. Do you have a GPA above a 2.6? (Sophomore & Juniors only) 3. What is the highest degree you plan to pursue? You can check more than one. High School Diploma Vocational/Technical School Degree 2 Year/Associate Degree 4 Year/Bachelor s Degree Master s Degree Doctoral Degree Unknown 4. Do you know what career you plan to pursue? A.) If yes, what career? B.) Do you know what major you will need to pursue this career? C.) Do you think you will change your career choice or major before you graduate from college? 5. Do you have a diagnosed learning disability? A.) If yes, please explain? 6. Have you taken an ESL class in the last 2 years? 7. Please rate the following on a scale of 1-5, with 1 being the lowest and 5 being the highest. A) Do you feel you are aware of all of your educational opportunities? (ie: College Fairs, College Visits) B) Do you feel your school provides good academic support? (ie: tutoring) C) Are you encouraged to take challenging courses? (ie: Pre AP, Advanced Placement, or Dual Credit Courses) D) How would you rate your self-confidence? E) How would you rate your self-esteem? F) How would you rate your social skills? Revised 1/14/13 Page 2

4 STUDENT EXPECTATION CONTRACT READ COMPLETELY: I will try my best to maintain a minimum GPA of 2.5 or above. I will seek tutoring in any class in which my grade is below an 80. I agree to take full advantage of the academic services offered. Working to the best of my ability, I will attend a minimum of TWO academic enrichment sessions per MONTH, and THREE Academic Saturdays per SEMESTER. I agree to turn in all necessary documents/paperwork in a timely manner. (i.e. permission slips, summer forms) I will do my best to attend class requirements during the school year and during my participation in the summer program. I agree to take full advantage of the college readiness and cultural activities offered by Upward Bound throughout the school year and during my participation in the summer program. (i.e. college visits/fairs, cultural events/trips,etc.) I agree to participate in the SIX WEEK summer residential program each summer. I agree to maintain frequent contact with an Upward Bound Advisor and/or Coordinator. I agree to conduct myself in a respectful manner while on and off my high school and Texas State University campus throughout the duration of my participation in Upward Bound. I will be courteous to all staff members and fellow Upward Bound participants. I will respect all programs, residence halls, classrooms, and university property. I commit myself to successfully graduate from High School and enroll in an institution of post-secondary education after completing high school. I agree to refrain from drinking alcohol or taking illegal drugs while involved in any Upward Bound activity. I understand there is a ZERO tolerance policy regarding this matter and if caught, I will be automatically terminated from Upward Bound. As a senior, I agree to meet all application, essay, and college entrance deadlines during the year. I understand Upward Bound is a FREE and at-will academic support and college preparatory program and any violation of these expectations could jeopardize my continued participation in the program. By signing I do hereby agree to comply with all of the following rules and expectations as a participant of the Texas State University Upward Bound Program. Printed Name of Student Signature of Student Date Printed Name of Parent Signature of Parent Date Signature of UB Director Date Revised 1/14/13 Page 3

5 ACADEMIC INFORMATION RELEASE FORM I,, (First Name) (Last Name) am applying for participation, or am currently a student in the Upward Bound Program at Texas State University. I authorize the staff of the Texas State Upward Bound Program to access academic and personal information in my/my student s legitimate educational interest. This information may include but is not limited to: public assistance, free & reduced lunch documentation; standardized test scores (PSAT, TAKS, STAAR, AP, SAT, ACT, TSI, GED); report cards; unofficial transcripts; official transcripts; attendance and disciplinary records; information about the status of post-secondary education admission/enrollment; financial aid documentation including Texas Common Application information, FAFSA pin code, SAR, and financial aid award letters in accordance with The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post-secondary education. I further understand all information received is for Upward Bound use only and is held strictly confidential. Furthermore, I give permission for Upward Bound to access and collect this information for a period of ten years or until I/my student successfully completes a program of post-secondary education. However, if I choose to withdraw this permission, I can call the Program Director at Print Student Name Student Signature Student ID# Student s Current School Print Parent Name Parent s Signature Date Signed The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. 1232g, and the Texas Public Information Act, Texas Government Code et seq., are respectively federal and state laws providing for the review and disclosure of student educational records. Texas State Upward Bound 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 and parent (if applicable), except as authorized by FERPA. Revised 1/14/13 Page 4

6 PERSONAL ESSAY In a 12pt Times New Roman font, double spaced, TYPED essay, please indicate why you wish to join the Upward Bound Program, how the program can assist you in high school and college success and what contributions you can make to the program. Use correct spelling, grammar, and punctuation. Organize your thoughts. Your response will be used to determine admission into the program. The essay must be between words. Attach your essay to your completed application. Feel free to use the space below to outline/draft your essay only. Remember, your essay must be TYPED. APPLICATION CHECKLIST: Completed Application Typed Student Essay (Prompt above) Letter of Recommendation Copy of Social Security Card Copy of Birth Certificate Income Tax form page 1 & 2 signed and dated by parent We need to have the number of exemptions and taxable income amount. (i.e form lines 6d & 43, on the 1040A form lines 6d & 27) Transcript (Sophomores, and Juniors only) Most recent report card Can be 8 th grade report card for freshman applying within the first 6/9 week period of the school year Most recent TAKS scores/ STARs scores Freshman can submit 8 th grade scores Revised 1/14/13 Page 5

7 Please give the attached Recommendation Form to a teacher or counselor at your high school. Remind your teacher/counselor to mail or fax these forms to our office as soon as possible. They can also return completed the Recommendation Form to you in a sealed envelope to submit with this application. RECOMMENDATION FORM (Completed by a Teacher/Counselor): Dear Teacher/Counselor: The student listed below is applying for admission into the Texas State University Upward Bound Program. 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 address below or fax to (512) 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 office at the number listed below. 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 CONDUCT IN CLASS WILLINGLY PARTICIPATES IN CLASS RESPECTS OTHERS AND THEIR PROPERTY ABILITY TO FOLLOW INSTRUCTIONS COMPLETES ASSIGNED WORK ON TIME STUDY SKILLS/HABITS ANALYTICAL THINKING SKILLS MATURITY/INTEGRITY PUNCTUALITY EAGER TO LEARN NEW THINGS/ TAKES INITIATIVE DEMONSTRATES MOTIVATION TO COMPLETE A 6-WEEK SUMMER PROGRAM 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. School Official Printed Name & Title address / Phone Number School Official Signature Date Texas State University-San Marcos 601 University Drive The Long House San Marcos, Texas p: toll free: f: Revised 1/14/13 Page 6