UPWARD BOUND 2011 Application

UPWARD BOUND 2011 Application TRIO programs, funded under Title IV of the Higher Education Act of 1965, help students overcome social, academic and cultural barriers to higher education. Form SouthArkUBA2007 1 of 12

Dear Parent: The following information describes the Upward Bound (UB) Program, explains what it does, who qualifies for it, the commitment participants must make, and how the selection process works. WHAT IS UPWARD BOUND? UB is a federally funded program, sponsored by the Department of Education. The program focus is to target, select and help qualified students that have the desire and potential to succeed in college and reach their goals. These students do not have to be the top students in their class, merely solid students with a certain academic, social and/or cultural need. Upon entrance into college they will have completed a minimum of 12 college hours that they may transfer to any college in Arkansas. Students selected for this program are eligible for all the services listed on the following pages. ALL of the services and activities provided by UB are at NO COST to participants or their families. The resources used are viewed as an investment in each student s future. The UB Program based at South Arkansas Community College (SouthArk) in El Dorado will work with fifty ninth grade students selected from applicants at El Dorado High School. Upward Bound is a unique and elite group. WHAT DOES UPWARD BOUND DO? The UB program assists selected participants in completing secondary school, enrolling in postsecondary school, and completing a bachelor s degree by providing intense academic, career, personal, and financial advising. It also provides academic instruction in literacy, mathematics, social science, and science, as well as tutorial services. Additionally it helps participants obtain college credit courses at SouthArk after their junior year of high school and provides cultural and recreational activities throughout the year to increase program, staff, and participant bonding. The UB program provides professional development opportunities and activities to strengthen and supplement the professional skills of the staff to enable them to more thoroughly aid the student participants. WHO QUALIFIES FOR UPWARD BOUND? Students selected for the UB program must meet family income guidelines as set forth by the federal government. Additionally, neither parent may possess a four-year college degree. WHAT COMMITMENTS DO UB PARTICIPANTS MAKE? UB participants do have to make quite a commitment to the program. They meet at least one hour a week after school at SouthArk with an college academic tutor, get academic and advising at EHS another day with the UB Coordinator, and receive support and enrichment in a variety of activities. Two Saturdays a month, students meet at SouthArk to work with academic instructors, prepare for ACT testing, travel to college campuses, and participate in other exciting social, recreational, and civic activities. During the summer, all UB participants are required to attend a six-week academic component on the SouthArk campus. As long as they meet the requirements of the program, participants remain in Upward Bound until graduation. UB students receive a participation stipend based on consistent participation. HOW ARE PARTICIPANTS SELECTED? The selection process is simple. Among the qualifications are family income and parental education. Therefore, we have to ask for some financial information. This information is completely confidential. We first interview qualified applicants. Then we interview the parent. This is an informal and comfortable process, which takes about half an hour. Afterwards we make final selections. Those selected start at the end of October or early November. Please keep in mind that we are only able to take 50 students. We hope that this letter answers a few of the questions that parents often ask. If you have any additional questions, feel free to call the Upward Bound office at (870) 864-7100 or contact your student s guidance counselor at El Dorado High School. Sincerely, Debra Mock Form SouthArkUBA2007 2 of 12

Instructions and Information The Student portion of the application must be completed by the student and the Parent/Guardian portion must be completed by the parent/guardian. The application deadline for 2007-2008 is October 5, 2007. What if I have Questions or need Help? If you have questions or need help, please talk with your guidance counselor, call the Upward Bound office at (870) 864-7100, or contact the Upward Bound Coordinator on your campus. To complete your application, please provide only the information requested in the following Application Checklist. Turn the completed packet in to your guidance counselor. Application Checklist The following application checklist provides the sections of the application you and your parent(s)/guardian(s) must complete. Return the Student/Parent(s) or Guardian(s) sections of the completed South Arkansas Community College Upward Bound Application Form to your counselor or to the Upward Bound Coordinator on your campus. Student/Parent(s) or Guardian(s) Section: Students and parent(s) or guardian(s) should provide all information in this section, which contains the following pages: Student Information Parent/Guardian Information Information Release Essay/Autobiography Questionnaire Your English, math, science teacher, and guidance counselor will be asked to complete a reference sheet on each applicant. You do not have to collect those forms. They will be completed and returned to the Guidance Office. After we receive your completed application we will review it. If you qualify, we will mail you or call you to set up an interview with you and your parent(s) or guardian(s). Once the interviews are completed we will make final selections. Regardless of whether or not you have been accepted you will receive a letter from us either welcoming you to the program or explaining to you why you were not selected. Form SouthArkUBA2007 3 of 12

Student Information Provide the following information as requested. Please print all written responses. Circle or check other answers as appropriate. If you have questions about completing the application, please contact your guidance counselor or the UB Coordinator on your campus. Name: Social Security No: - - Last First Middle (Required) What is your preferred name? Address: Phone: ( ) D.O.B. / / City: State: Zip: Elementary School: Middle School: Junior High School: High School: Did you repeat a grade? Yes (If yes which grade?) No In what grade are you currently? Gender: Male Female Ethnic Origin: African American/Black Are you: a U.S. citizen Asian an eligible non-citizen (please attach a Caucasian copy of your immigration documentation) Hispanic/Latin American Other Native American How many hours a day (including weekends) do you spend in helping around the house doing things such as babysitting, working at a family business or cooking. What is the primary language(s) spoken in your home? English English/Spanish Other: How did you hear about this program? Guidance Counselor Teacher UB STAFF Other What do you plan to do after you graduate high school? (Check all that apply) Attend a four-year college Enroll in a technical college program Get a job Other (Please Specify) Attend a community college for a one or two year degree Enlist in the military Attend a trade school In what areas can Upward Bound help you? (Use numbers and rank all the following that apply to you in order of importance with 1 being the most important and 14 being the least important). Manage my time Improve my grades Prepare for tests Choose a career Build my self-esteem Explore ways to pay for college Visit new places Meet new people Learn about college options Develop new interests Learn about other cultures Study skills Visit college campuses Other What courses have you taken or are you currently taking? (Check all that apply) Algebra I Algebra AB Biology Algebra II Algebra CD Chemistry Geometry Integrated Algebra Other Math or Science (List course name) Geometry Investigation Physical Science What obstacles or difficulties, if any, do you face that may affect your educational and career plans? What are your sleep habits? (For example: I go to bed before 10:00 pm, I stay up past midnight, and it is very hard for me to get up in the morning) Form SouthArkUBA2007 4 of 12

Parent(s)/Guardian(s) Information This section must be completed by the student s parent(s)/guardian(s). If you have questions or would like assistance with the application, please call Debra Mock or Roy Williams at SouthArk s Upward Bound office (870) 864-7100. Confidentiality No one is allowed to see the information you provide unless he/she is an employee of South Arkansas Community College Upward Bound Program or otherwise authorized to see this information. All information provided in this section is protected by the Privacy Act and is not specifically reported to the federal government or the U.S. Department of Education. However, the Department of Education does have the authority to gather general statistical data about program participants in order to improve and measure the success of the Upward Bound Program. Father/Male Guardian Mother/Female Guardian Last First Middle Initial Last First Middle Initial Highest Education Level Completed: Highest Education Level Completed: Elementary School (K-8) Elementary School (K-8) High School (9-12) High School (9-12) Associate s Degree Associate s Degree Bachelor s Degree or beyond Bachelor s Degree or beyond Marital Status: Married Divorced Separated Unmarried Widowed Other Student s Primary Residence: Parent(s)/Guardian(s) Name(s) Occupation/Work Phone Number/Taxable Income: If parents are separated, this section should be completed by the parent with whom the student lives, or by the parent/guardian providing at least 50% of student s financial support. You must fill in all blanks. Parent s/guardian s Occupation: Male: Female: Parent s/guardian s Work Phone Number: Male: ( ) Female: ( ) Parent s working number of hours per week More than one job? Where? Parent s/guardian s taxable income (see line 42 of 2009 Form 1040, line 27 of 2009 1040A or line 6 of 2009 1040EZ) If income was $0, please explain. Number of People in Household: Adults Children Number of Siblings: Brothers Sisters Half-Brothers Half-Sisters Verification: I certify by signing below that the above information is correct and that any false or misleading information may result in disqualification of the applicant. Parent/Guardian Signature Parent/Guardian Signature Form SouthArkUBA2007 5 of 12

Information Release Please print your first name, middle initial, and last name where indicated in the following release statement. Afterwards, both student and parent(s) or guardian(s) must sign and date this request. I (First Name) (Middle Initial) (Last Name) authorize South Arkansas Community College Upward Bound Program and High School to release and/or receive copies of my son s/daughter s/ward s academic records, including, but not limited to transcripts, grade reports, test scores, evaluations, attendance and medical records, disciplinary actions, and other records necessary to for participation in the program. This information may be used for any federal reports of the Upward Bound program. Otherwise, these records will remain confidential and will only be used by the Upward Bound staff. This release is to be effective throughout my high school and college career, and will end only upon college graduation or termination from the Upward Bound program. Student Signature Parent/Guardian Signature Parent/Guardian Signature A FEDERALLY FUNDED PROGRAM TRIO programs, funded under TITLE IV of the Higher Education Act of 1965, helps students overcome social, academic and cultural barriers to higher education. Form SouthArkUBA2007 6 of 12

Essay/Autobiography Please write a short autobiographical essay of your life history. The information you include here is confidential and is essential in consideration for selection in the Upward Bound Program. If you require additional space you may write on the back of this page or attach an additional sheet of paper. Be concise and include the following information. Family, people or events that have had a significant impact on your life Personal goals, hopes and dreams Career interests Why you want to be a part of the Upward Bound Program Hobbies, likes, dislikes and anything else that will help us to get to know you better Form SouthArkUBA2007 7 of 12

Questionnaire Name four friends whom you most admire and why. 1. Why? 2. Why? 3. Why? 4. Why? Using the scale Not at all Not likely Likely Very likely rate yourself on the following statements. Get tattoos/body piercing (other than ears) Enter College Spend four hours in a chat room Complete High School Complete a College Degree Wait until the night before to study for a final exam Identify two places in Arkansas you would like to visit. 1. 2. Identify two places in the United States you would like to visit. 1. 2. Identify two places in other countries you would like to visit. 1. 2. Form SouthArkUBA2007 8 of 12

English Teacher Reference Student Name School Grade Course Teacher Name Teacher: The applicant above has applied to the SouthArk Upward Bound Program. Please answer the following questions and evaluate this student as objectively as possible. All information is confidential. If you have questions, please call Debra Mock or Roy Williams at (870) 864-7100. Thank you for your assistance. Important: After completion, please return this form to the school guidance counselor as soon as possible. Do not return it to the student. Yes No 1. Do you feel that this student had/has an adequate background for this class? 2. Did/Does this student ask for additional help? 3. Did/Does this student take adequate notes? 4. Did/Does this student have a positive attitude in this class? 5. Did/Does this student complete and turn in homework assignments consistently? 6. Do you feel that this student knows how to study? 7. Did/Does this student demonstrate punctuality? 8. Did/Does this student cooperate with school officials? 9. Has this student expressed an interest in post-secondary education? 10. Do you feel that this student has acceptable social skills? 11. Do you feel that this student has a need for more cultural awareness? 12. To the best of your knowledge, does this student have any illegal habits? (for example, underage tobacco use, alcohol, drugs, etc.) 13. Do you feel that this student has the potential to succeed in college? 14. Do you feel that this student interacts well with his/her peers? 15. What services would you recommend for this student to prepare him/her for high school and/or college? 16. How would you rank this student on a 1-5 scale, with 5 being the highest? (Check the ranking) 1 3 5 (Please make comments as needed. If you require additional space you may write on the back of this page) Teacher Signature Form SouthArkUBA2007 9 of 12

Math Teacher Reference Student Name School Grade Course Teacher Name Teacher: The applicant above has applied to the SouthArk Upward Bound Program. Please answer the following questions and evaluate this student as objectively as possible. All information is confidential. If you have questions, please call Debra Mock or Roy Williams at (870) 864-7100. Thank you for your assistance. Important: After completion, please return this form to the school guidance counselor as soon as possible. Do not return it to the student. Yes No 1. Do you feel that this student had/has an adequate background for this class? 2. Did/Does this student ask for additional help? 3. Did/Does this student take adequate notes? 4. Did/Does this student have a positive attitude in this class? 5. Did/Does this student complete and turn in homework assignments consistently? 6. Do you feel that this student knows how to study? 7. Did/Does this student demonstrate punctuality? 8. Did/Does this student cooperate with school officials? 9. Has this student expressed an interest in post-secondary education? 10. Do you feel that this student has acceptable social skills? 11. Do you feel that this student has a need for more cultural awareness? 12. To the best of your knowledge, does this student have any illegal habits? (for example, underage tobacco use, alcohol, drugs, etc.) 13. Do you feel that this student has the potential to succeed in college? 14. Do you feel that this student interacts well with his/her peers? 15. What services would you recommend for this student to prepare him/her for high school and/or college? 16. How would you rank this student on a 1-5 scale, with 5 being the highest? (Check the ranking) 1 3 5 (Please make comments as needed. If you require additional space you may write on the back of this page) Teacher Signature Form SouthArkUBA2007 10 of 12

Science Teacher Reference Student Name School Grade Course Teacher Name Teacher: The applicant above has applied to the SouthArk Upward Bound Program. Please answer the following questions and evaluate this student as objectively as possible. All information is confidential. If you have questions, please call Debra Mock or Roy Williams at (870) 864-7100. Thank you for your assistance. Important: After completion, please return this form to the school guidance counselor as soon as possible. Do not return it to the student. Yes No 1. Do you feel that this student had/has an adequate background for this class? 2. Did/Does this student ask for additional help? 3. Did/Does this student take adequate notes? 4. Did/Does this student have a positive attitude in this class? 5. Did/Does this student complete and turn in homework assignments consistently? 6. Do you feel that this student knows how to study? 7. Did/Does this student demonstrate punctuality? 8. Did/Does this student cooperate with school officials? 9. Has this student expressed an interest in post-secondary education? 10. Do you feel that this student has acceptable social skills? 11. Do you feel that this student has a need for more cultural awareness? 12. To the best of your knowledge, does this student have any illegal habits? (for example, underage tobacco use, alcohol, drugs, etc.) 13. Do you feel that this student has the potential to succeed in college? 14. Do you feel that this student interacts well with his/her peers? 15. What services would you recommend for this student to prepare him/her for high school and/or college? 16. How would you rank this student on a 1-5 scale, with 5 being the highest? (Check the ranking) 1 3 5 (Please make comments as needed. If you require additional space you may write on the back of this page) Teacher Signature Form SouthArkUBA2007 11 of 12

Guidance Counselor Referral Please complete the following information and attach a current transcript along with test scores and a copy of current Iowa and/or Plan testing. If you have questions, please call Debra Mock or Roy Williams at (870) 864-7100. Thank you for your assistance. Student Name School Grade Guidance Counselor Name Please check one of the following answers. You may provide additional comments in the space provided. I highly recommend this person for the Upward Bound Program I recommend this person for the Upward Bound Program I recommend, with reservations, this person for the Upward Bound Program I do not recommend this person for the Upward Bound Program Comments: Guidance Counselor Signature Form SouthArkUBA2007 12 of 12