Weatherford College Upward Bound Application Checklist & Requirements for 2018-19 All portions must be completed by both student and parent/guardian. Completed All Sections of the Upward Bound Application Provided a copy of the parent/guardian(s) current income tax return, DHS verification of income, or signed statement of parent/guardian regarding income earned during the previous year. Completed release of information forms (One will remain with counselor and one will remain with Upward Bound). Copy of student s most recent transcript, most recent report card and/or access to Parent Portal/Online grading System. Return completed information to your school counselor s office by designated deadline of September 29, 2017. Upward Bound will not process incomplete applications. When all of the above items have been completed and it is determined that the student qualifies for the program, an interview will be conducted. After interviews have been completed for all qualified applicants, the applicants will be reviewed and the new students will be notified by UB staff of their admission or non-admission into the Upward Bound program at Weatherford College. Form must be viewed in Adobe Acrobat to use the "Submit by Email" Button Found on the Last Page Or return the printed form to your high school counselor or UB staff For more information contact Weatherford College Upward Bound: Upward Bound Weatherford College 225 College Park Drive Weatherford, TX 76086 Office 817-598-6441 Jeff Kahlden, Director, jkahlden@wc.edu, 817-598-6485 Christine Endy, Counselor, cendy@wc.edu, 817-598-6480 The Upward Bound Program at Weatherford College is 100% federally funded by the U.S. Department of Education for $263,938 annually. The program welcomes and encourages participation by interested individuals regardless of race, national origin, gender, or disability.
Dear Parents/Guardians of Upward Bound Student Applicant: Your student has indicated an interest to apply for selection to the Weatherford College Upward Bound Program. Upward Bound is a FREE college preparatory program for high school students 100% funded by the U.S. Department of Education and sponsored locally by Weatherford College. Upward Bound is specifically designed to increase the academic, social, and leadership skills for its students. In our contract with the U.S. Department of Education, we agree to work with parents to educate them about our program and how they can involve themselves in their student s education. As you and your son/daughter consider his/her application to Upward Bound, we provide you with this information about Upward Bound and post-secondary opportunities. WC Upward Bound is a federally funded program and the only cost to each of its participants is that of commitment, time, effort, and entering and completing post-secondary training. During the academic school year (September-May), your student will attend Saturday meetings for academic enrichment and tutoring. WC Upward Bound will have 10 Saturday meetings in an academic school year. Excused absences will be allowed for school, church, and/or other special reasons. Your student will be participating yearly in a 4 to 6 week supervised summer academic residential program at Weatherford College. (The cost is free and considered a $3500 yearly scholarship) When involved with WC Upward Bound, your student is required to take college prep courses throughout high school. Your student will also take all college entrance exams at no cost to you. Your student will have to take the PSAT, SAT, ACT, and TSI (if needed) during their participation in Upward Bound. Upward Bound will provide fee waivers for the student to take these tests. When your student graduates from high school and is still a regular participant in the UB program, that student will have the opportunity to take two college courses at no cost to the student or parent(s). (An estimated $1500- $2000 scholarship) By participating in the WC Upward Bound program, your student will learn about college opportunities everywhere in Texas and across the nation not just Weatherford College. Your student will have help applying for financial aid and scholarships through WC Upward Bound. UB staff will help your student apply, but cannot promise that your student will be eligible for financial aid or scholarships. WC Upward Bound students will explore careers that might best suit his/her interests. Upward Bound will also provide students cultural and social experiences to invigorate and expose them to new opportunities. WC Upward Bound will make weekly visits with your student in their respective high schools. The Weatherford College Upward Bound may request a Student/Parent conference at any time and will advise your student on classes that they should take in high school. Student s parents are required to attend all mandatory Parent Day meetings. There are approximately 2-4 parent/guardian meetings throughout the academic year. There are additional opportunities for parents/guardians to be involved while their student is participating in Upward Bound. If you have further questions, please contact one of our Upward Bound staff members. Thank you for your interest in Upward Bound. Sincerely, Jeff Kahlden, MS Director of Upward Bound Weatherford College jkahlden@wc.edu 817-598-6485 2018/19 Weatherford College Upward Bound Application Page 2
Weatherford College Upward Bound Student Application 2018-19 Please print clearly in black or blue ink. Be sure to complete all blanks on the application. First Name Middle Initial Last Name Current Age: Social Security Number (optional): Gender: Current Grade Level: Date of Birth High School Currently Attending: Female Male How Many Years Attended: Student s T-Shirt Size Mailing Address: City State Zip Code Student s Cell Phone Number: 1st Parent/Guardian Name 1st Primary Contact Parent/Guardian s Phone Number: 1st Parent/Guardian s Email Address Student s Email Address: 2nd Parent/Guardian Name 2nd Primary Contact Parent/Guardian s Phone Number: 2nd Parent/Guardian s Email Address Approximately how many miles do you live from the high school that you are attending? Do you have access to the internet at home? YES NO Ethnic Background: African American or Black American Indian Asian/Pacific Islander Hispanic White/Caucasian Mixed Race/More than one race Other (please specify) What is the primary language spoken in your home? English Spanish Other (Please Specify) What grades do you usually receive in your classes? Check all that apply. A (90-100) B (80-89) C (70-79) F (69-Below) Are you currently or planning to take any Pre-AP or AP courses? YES NO Not Sure Did you take Algebra I as an 8 th Grader? YES NO Not Sure Are you currently or planning to take dual/college credit courses? YES NO Not Sure Students Academic Access/Parent Portal: Please provide the UB Staff with the User name and Password for the Online Grading System/Parent Portal to allow the staff to review your grades (leave blank if you do not have access): User Name Password 2018/19 Weatherford College Upward Bound Application Page 3
Are you participating or planning to participate in extracurricular activities? If YES, Please list: What type of career or major would you like to pursue after high school? 1 st choice 2 nd choice 3 rd choice YES NO Not Sure Are you a current member of Weatherford College Talent Search? YES NO Not Sure Please list the names of the Science, Math, or English teachers that you want your teacher reference forms sent to (previous years teachers are acceptable): Name: Subject Taught Email Address: Name: Subject Taught Email Address: Name: Subject Taught Email Address: Student s Citizenship Status Please check the following citizenship status for your student applying for WC Upward Bound. United State Citizen Permanent Resident Alien Card Number: An individual is eligible to participate in a Regular, Veterans, or a Math and Science Upward Bound project if the individual meets all of the following requirements: (a)(1) Is a citizen or national of the United States. (2) Is a permanent resident of the United States. (3) Is in the United States for other than a temporary purpose and provides evidence from the Immigration and Naturalization Service of his or her intent to become a permanent resident. (4) Is a permanent resident of Guam, the Northern Mariana Islands, or the Trust Territory of the Pacific Islands.(5) Is a resident of the Freely Associated States the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau. If your student is a permanent resident alien, you will be asked to provide a clear, color copy of their Alien Registration card (front and back). Student Handicap Eligibility Statement Does the student applicant have any physical disabilities, learning disabilities, and/or emotional condition(s) that Upward Bound needs to be aware of at this time? Please mention any disabilities that necessitates specifically designed instructional materials or programs, modified physical facilities, and/or related services to the program at Weatherford College. YES NO If Yes, Please specify the disability or emotional condition: 2018/19 Weatherford College Upward Bound Application Page 4
STUDENT SHORT ESSAY SECTION (Additional, separate, or back of page may be used) TO BE COMPLETED BY THE STUDENT this is your chance to sell yourself and stand out from all the other applications! Take this opportunity to allow us to get to know you. Use complete sentences, correct grammar, and punctuation. WC Upward Bound will use these answers in helping select students for the program. What are the reasons that Upward Bound appeals to you as a student? In what school subject(s) do you need assistance? In what subject(s) do you do well in? How do you feel high school will prepare you for college? Write a brief paragraph describing your educational and career goals. Please explain how you plan to achieve those goals and describe these goals in your paragraph. Please include why you want to go to college. 2018/19 Weatherford College Upward Bound Application Page 5
PARENT/STEP-PARENT/GUARDIAN SECTION This section is to be completed by the parent/step-parent/guardian of the student applying for the Weatherford College Upward Bound Program. To be eligible for services, Weatherford College Upward Bound will need to verify the student s family income. This is required by the federal government for all Upward Bound student applicants. Therefore, withholding information will hinder the student applicant from being eligible for the Upward Bound program. WC Upward Bound will not share any information with any outside entities. This information is private and will be kept securely in the Upward Bound office and will be shredded in the event that the student does not receive admission into Upward Bound. The staff at Upward Bound will use this information to determine the student s eligibility into the Upward Bound program. Marital status of Guardians: Married Married, living apart Divorced Unmarried With whom does the student live: Both Parents Mother Only Father Only Foster Parent(s) Mother/Stepfather Father/Stepmother Legal Guardian (please indicate relationship) Other (please indicate relationship Mother/Female Guardian Information: Father/Male Guardian Information: Name: Name: Employer: Position/Job Type: Highest Level of Education Attained (please Mark) No High School attended (K-8 th Grade) Some High School Attended (9 th -12 th Grade/Did not Graduate) High School Diploma/GED Certificate Attended some college (Did not attain a certification or Degree) Technical or Vocational School Certification/Degree Completed Associates Degree Name of college: Completed Bachelor s Degree Name of College/University: Other Educational Certificates (Please List) If you are currently enrolled in a program of higher education, please list the name of College/University? Name of College/University: Employer: Position/Job Type: Highest Level of Education Attained (please Mark) No High School attended (K-8 th Grade) Some High School Attended (9 th -12 th Grade/Did not Graduate) High School Diploma/GED Certificate Attended some college (Did not attain a certification or Degree) Technical or Vocational School Certification/Degree Completed Associates Degree Name of college: Completed Bachelor s Degree Name of College/University: Other Educational Certificates (Please List) If you are currently enrolled in a program of higher education, please list the name of College/University? Name of College/University: 2018/19 Weatherford College Upward Bound Application Page 6
Full name List the people in parent(s) household Age Relationship to Student (mother, father, brother) STUDENT Grade Enrolled Or College Enrolled Occupation (if working) Please attach a separate piece of paper with the above information for each additional person(s). Did you, the parent(s), file taxes for 2017? (filing by April, 2019) YES NO Not Sure Do you have a copy of your 2017 filed taxes? YES NO Not Sure If yes, please provide a SIGNED COPY of your 2016 Income Tax forms (1040, 1040EZ, 1040A) and all W-2s (if available). If needed the UB staff will make a copy and return the originals to you. Federal Trio Programs-Annual taxable Family Income Levels by family size (Effective January 18, 2018) Check the box that applies to your household size Size of Family Maximum Taxable Income Level for Eligibility (office use only) 1 $18,210 2 $24,690 3 $31,170 4 $37,650 5 $44,130 6 $50,610 7 $57,090 8 $63,570 Other (please list) 63,570 + (additional family X $6,480) = The term low-income individual means an individual whose family taxable income for the preceding year did not exceed 150 percent of the poverty level amount. If you are unable to provide 2017 IRS Tax Return, please fill out the following: Please fill out each blank with the most accurate number that you can to show the amount of financial support you and/or your student received in the 2017 year: Parent(s) Wages: $ Household SSA/SSI: $ (Social Security) Parent(s) Vet/GI Bill $ Parent(s) Unemployment $ Parent(s) Pension/Retirement $ Household SANP/WIC $ Household TANF $ Child Support Received $ Other $ Other $ Source Source Free and Reduced Lunch Please include any additional information or narrative that the Upward Bound staff needs to know regarding the financial status of the student s family. You may write this on the back of this application page or on another sheet of paper. YES NO 2018/19 Weatherford College Upward Bound Application Page 7
Upward Bound Program Application and Understanding of Commitment By completing this Upward Bound application for Weatherford College, I acknowledge that all of the information that is provided on these forms is true and complete to the best of my knowledge. I understand that by completing this form does not guarantee that I am automatically a member of the Upward Bound program at Weatherford College. Additionally, if accepted into the Upward Bound program at Weatherford College, I will do my best to commit to the following activities during my entire high school career: Fulfillment of all requirements of Upward Bound-Attendance, cooperation, grades, tutoring, goals while I am a member. Fully participate in a four to six week summer program for the remainder of my high school experience that is typically held between June 1-July 15 each year of high school. Fully participate in enrollment in college preparatory classes (such as AP courses, dual enrollment, etc.) at my high school. Fully participate in enrollment in and my commitment to complete a course of study in post-secondary education. This is to certify that all information provided is true and accurate to the best of my knowledge. I hereby give my permission for the Upward Bound program at Weatherford College to have access to any school or agency records of, to determine eligibility for the program and to monitor the status and (Student s Name) progress in secondary school. Further permission is granted to request information and records from any and all postsecondary institutions in order to track college progress. I understand that all records will be kept in strict confidence and in accord with the Privacy Act of 1974. I hereby apply for admission to the Upward Bound Program at Weatherford College and agree to abide by the rules and regulations set forth by the program. I understand that should I be accepted, I will remain in the program throughout my high school years and will continue and complete a course of study beyond high school. Student Signature Date Parent/Guardian Signature Date 2018/19 Weatherford College Upward Bound Application Page 8
Weatherford College Upward Bound Release Form The following consent shall be valid for the duration of my son/daughter s membership in Upward Bound or completion of high school, and until completion of a bachelor s degree or for 7 years following graduation from high school. As per the US Department of Education, academic records regarding grades, test scores, and progression of Upward Bound students are collected, maintained, and monitored by Upward Bound programs throughout high school and college. I hereby grant permission for my son/daughter, to participate in the (Student s Name) Weatherford College Upward Bound Program, including its residential summer program and academic year program. I also give my consent for the following: For the high school where my son/daughter is enrolled to make available to the Director of the Upward Bound Program (or to any staff member that may be so designated) any and all information pertaining to my child s academic progress in school. (For example: transcripts, report cards, test scores, or any other necessary information). For my son/daughter to participate in field trips in provided transportation. For my son/daughter to be visited in the schools by Upward Bound Staff. For my son/daughter to receive individual and group counseling from the Upward Bound Staff or interns affiliated with the Upward Bound Program. For the use of my child s name and picture by the media. I release Weatherford College from any liability related to the publicity involving my child. For the Upward Bound program to monitor my son/daughter s academic progress after high school until completion of a bachelor s degree, or for a period of 7 years, through the availability of any and all information pertaining to my child s academic progress in post-secondary education provided by the institutions of post-secondary education. I will support my son/daughter s interest in being a member of Upward Bound by encouraging regular attendance and active involvement in all activities. As a parent, I will fully support the goals of the program, participate in program activities, and help my son/daughter to attain these goals. Student Name (Please Print) Parent/Guardian Signature Date 2018/19 Weatherford College Upward Bound Application Page 9
Student s Last Name Student s First Name Middle Initial Weatherford College Upward Bound Release Form The following consent shall be valid for the duration of my son/daughter s membership in Upward Bound or completion of high school, and until completion of a bachelor s degree or for 7 years following graduation from high school. As per the US Department of Education, academic records regarding grades, test scores, and progression of Upward Bound students are collected, maintained, and monitored by Upward Bound programs throughout high school and college. I hereby grant permission for my son/daughter, to participate in the (Student s Name) Weatherford College Upward Bound Program, including its residential summer program and academic year program. I also give my consent for the following: For the high school where my son/daughter is enrolled to make available to the Director of the Upward Bound Program (or to any staff member that may be so designated) any and all information pertaining to my child s academic progress in school. (For example: transcripts, report cards, test scores, or any other necessary information). For my son/daughter to participate in field trips in provided transportation. For my son/daughter to be visited in the schools by Upward Bound Staff. For my son/daughter to receive individual and group counseling from the Upward Bound Staff or interns affiliated with the Upward Bound Program. For the use of my child s name and picture by the media. I release Weatherford College from any liability related to the publicity involving my child. For the Upward Bound program to monitor my son/daughter s academic progress after high school until completion of a bachelor s degree, or for a period of 7 years, through the availability of any and all information pertaining to my child s academic progress in post-secondary education provided by the institutions of post-secondary education. I will support my son/daughter s interest in being a member of Upward Bound by encouraging regular attendance and active involvement in all activities. As a parent, I will fully support the goals of the program, participate in program activities, and help my son/daughter to attain these goals. Student Name (Please Print) Parent/Guardian Signature Date Form must be viewed in Adobe Acrobat to use the Submit Button 2018/19 Weatherford College Upward Bound Application Page 9