Federal TRIO Programs
Current-Year Low-Income Levels
(Effective January 12, 2022 until further notice)

For family units with more than eight members, add the following amount for each additional family member: $7,080 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,850 for Alaska; and $8,145 for Hawaii. 

The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount. 

The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The 2022 poverty guidelines are in effect as of January 21, 2022. Federal Register notice was published January 21, 2022. 

(Remember to enclose a copy of your social security card or permanent residency card.)

The information contained in this section of the application is accurate and complete to the best of my knowledge. If admitted to participate in UB, I agree to abide by all rules and regulations governing the program (including, but not limited to, permission for UB to obtain information from all secondary and post-secondary schools in which I am, have been, or will be enrolled through my twenty-fifth birthday) and to participate in all the activities of the program unless prevented by illness or other hindrances beyond my control.

This survey contains a number of statements about student needs. Please give your honest opinion of how the Upward Bound program can meet your needs.

Household Information

Please list everyone living in the applicant's household (including applicant):

Financial Information
I understand that Upward Bound must verify income for acceptance into the program.

(An agency statement from the Social Security Administration or the Department of Human Services is required.)

• I agree to achieve and maintain a 2.5 Grade Point Average
• I agree to contact my Upward Bound counselor if there is a change in my class schedule, my home address or phone number, and/or if my family plans to move from the target area.
• I agree to seek help with academic or personal problems if needed.
• I agree to attend school regularly and not miss more than 8 days of school per semester.
• I agree to participate in tutoring sessions as needed and/or recommended by my counselor or teacher.
• I agree to achieve my goals that have been set up with the help of my UPWARD BOUND counselor.
• I agree to take advantage of special UPWARD BOUND activities, like the career fair, college visits, summer enrichment program, financial aid workshops, and other activities the staff implement.
• I agree to enroll in a postsecondary educational institution upon graduation from high school.
• I will abide by all the rules and regulations of the Upward Bound program. (See UAHT Upward Bound Handbook)

For my child to remain eligible to participate in the UPWARD BOUND PROGRAM, I will:

1. Immediately notify the UPWARD BOUND counselor if my child receives disciplinary action at school.
2. Attend UPWARD BOUND parent workshops and conferences throughout the school year.
3. Encourage my student to attend tutoring sessions and Upward Bound meetings while adhering to all Upward Bound policies and procedures.
4. Notify the UPWARD BOUND office of address and phone number changes.
5. Provide transportation to participant for campus activities.

My goal is to assist my child in succeeding in his/her education

IN CASE OF EMERGENCY
If parent cannot be reached, name of person to notify or to whom we can release student:

Of the above, these are current or recurring:

Physician Information

Health Insurance

Please complete this form in its entirety. Copies of these records are retained for the benefit of your child while he/she is on the UAHT campus.

Immunization Record

Medical Release
I hereby authorize the UPWARD BOUND Program to provide emergency medical and dental services for my child __________________(Name). I will not in any way hold UAHT or the Upward Bound Program responsible for any treatment or medication deemed necessary for medical or dental services.

Parental Release for Student Travel
I authorize the Upward Bound Program to provide transportation for my child_____________(Name) to program activities. I hereby release the Upward Bound Program and UAHT from any responsibility for any criminal act of malice, vandalism, theft, or any other unlawful behavior during trips sponsored by the Upward Bound Program.

TO THE APPLICANT: Please type or print your personal information on each Transcript and Grade Release form. Give one form to your school counselor, and attach the other one to your Upward Bound application.

TO THE PARENT/GUARDIAN: Please read and sign the release statement below so that we will receive an official copy of his/her school transcript. Your son’s/daughter’s application is not complete without a signed transcript and grade release form, It is your responsibility to check to be sure the school has sent us these records, including information for the current school year. For the student named above, I hereby authorize the UPWARD BOUND PROGRAM at the University of Arkansas Hope-Texarkana to have access to any school or agency records, including an official transcript of all grades as well as the results of academic testing. This information will be used to determine eligibility for the program and to monitor his/her academic progress.

TO THE SCHOOL: The student named above is applying for admission to the Upward Bound Program at the University of Arkansas Hope-Texarkana. Please send us an official copy of the following information:

• Transcript
• ACT, PSAT and Aspire test scores.