1. Enrolled as a 9th, 10th, or Rising 9th grade student.  Rising 9th graders are eligible for the Summer Program Session. 
2. Potential First Generation College Student – neither parent has earned a four year college degree. 
3. Meet family income eligibility requirements. 
4. Have an academic need. 
5. Interested in working with the Upward Bound Program to prepare for a successful college life. 
6. Ability to commit to being present two Saturdays per month during the regular school year and present for a six-week summer program, both provide enrichment instruction and cultural field trips. 

I have read the above requirements and agree to abide by them and participate fully in all scheduled activities (except in case of sickness or emergency), if accepted into the Upward Bound Program at Gadsden State Community College.

I certify that all of the information I am providing on this application is correct and complete.

Please answer all questions

17.  Needs Assessment.  Which areas below do you feel you need help with? (check all that apply)

(If married, both parents’ income tax returns required).

** Applicants will need to provide a copy of your Federal Income Tax information at the time of the interview in the Upward Bound Office.

This information is being submitted so that my child, __________________, may be considered for participation in the Upward Bound Program at Gadsden State Community College, Harry M. Ayers Campus. I understand that this information will be held in strict confidence and will not be distributed to other agencies. I have read the program admission requirements for the Upward Bound Program and fully understand the obligation my child is assuming. I fully support my child’s decision to participate in the program and will assist my child in upholding the obligation made to the Upward Bound Program.

I certify that all of the information on this application is correct and complete, including the information concerning family income.

It is the official policy of the Alabama State Board of Education and Gadsden State Community College, a postsecondary institution under its control, that no person shall, on the grounds of race, color, disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity or employment.

Note to the Student/Parent

The Gadsden State Community College Upward Bound Program is required to follow the performance and progress of our participants through their college career. This release will be forwarded to high school and college registrars allowing our program staff to receive copies of your school records for tracking and reporting purposes. This release as dated below will serve as the only records release form valid from the date signed until completion of your postsecondary program of study.

Note to High School and College Registrars 

The Gadsden State Community College Upward Bound Program is mandated by the U.S. Department of Education to follow the progress of program participants through their high school and college careers. This release as dated below is the only release form to be used by our program. Due to the transient nature of students, it will become nearly impossible to seek annual updates of this release. The signatures below indicate that they realize this release (as dated below) will be used for many years in the future once they complete our college preparatory program. Thank you for honoring our request for information. 

Student/Family Agreement 

I understand that as part of the Gadsden State Community College Upward Bound selection process, my child’s school records (including transcripts, report cards, financial aid status, standardized test scores and academic progress reports) may need to be examined by the Upward Bound staff. I also understand that Upward Bound will continue to require this information throughout the duration of my child’s high school and college careers. 
 
I hereby give permission to the Gadsden State Community College Upward Bound Program to request the following information from my child’s high school or institution of postsecondary education at this time or anytime in the future as needed and extend its validity from the date signed until completion of their postsecondary program of study. 

1. School Records
2. Standardized Test Scores
3. Report Cards/Transcripts
4. Student Status and Performance with the Institution
5. Student Financial Aid Status
6. Student Current Mailing Address and Telephone Number