Austin Community College-UB 1

Upward Bound Application

5930 Middle Fiskville Rd. Suite 509.2 Austin, TX 78752

https://www.austincc.edu/academic-and-career-programs/dual-credit-programs/upward-bound/about-the-program

Federal TRiO Program Funded by the U.S. Department of Education

Austin Community College is an equal opportunity employer. It is College policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, sex, religion, national origin, disability, veteran’s status, or other protected classifications.

Parent Information
Dear Parent/Guardian:

Your child has indicated an interest and/or has been nominated to apply for selection to the Upward Bound (UB) Program at Austin Community College. Upward Bound (UB) Program is a free college preparatory program for high school students funded by the U.S. Department of Education and sponsored locally by Austin Community College. UB is specifically designed to strengthen the math, science, English and foreign language skills of eligible high school students to excel academically and pursue postsecondary degree.

Year-round services provided by the UB Program of Austin Community College include:
- Instruction in math, science, English and foreign language, including hands-on experience in laboratories, in computer facilities, and at field sites;
- A 6-week summer instructional component that is designed to simulate a college-going experience that includes daily coursework in math, science, English and foreign language as well as other related activities such as field trips and special events;
- Activities that involve participants with opportunities to learn from professionals who are engaged in research on campus, or who are engaged in research or applied science at hospitals, governmental laboratories, or other public and private agencies;
- Academic advising from UB staff and individual assistance with the college admissions and financial aid application process.
After school tutoring and Academic Saturdays during the school year will take place at target high school as well as the six-week instructional session (Summer Component) that takes place during the summer at the Riverside campus. Please note that selected students and their parents must commit to remain active in the UB Program year-round (12 months) for a minimum of 3-4 years or until high school graduation.

In order to comply with federal regulations, all UB participants must meet the following criteria:
- Indicate an interest in attending college;
- Demonstrate academic need (low grades and/or low test scores);
- Qualify as Low Income and/or Potential First Generation College Student (neither parent has received a 4-year college degree);
- Commit to remain active in UB until high school graduation
Please complete this application and return with your child’s Student Application to the address or fax number listed above. You may also return your completed application to your child’s school counselor. All completed applications will be reviewed and eligible applicants will be contacted for a Student & Parent Interview with program staff.

Thank you for your interest in the Upward Bound Program at Austin Community College. Please call a UB staff member at 512-223-1464 if you have any questions or need additional assistance.

Sincerely,
Upward Bound Program Staff

Parent Application
Parent or Guardian #1's Name*

First NameLast Name
Parent or Guardian #1's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian #1's Home / Cell Phone Number*
(999)999-9999
Parent or Guardian #1's Email*
example@example.com
Parent or Guardian #1's Employer
Parent or Guardian #1's Occupation
Parent or Guardian #1's Work Number
(999)999-9999
Has Parent or Guardian #1 received 4-year degree from a college or university?*

YesNo
Parent or Guardian #2's Name

First NameLast Name
Parent or Guardian #2's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Guardian #2's Home / Cell Phone Number
(999)999-9999
Parent or Guardian #2's Email
example@example.com
Parent or Guardian #2's Employer
Parent or Guardian #2's Occupation
Parent or Guardian #2's Work Number
(999)999-9999
Has Parent or Guardian #2 received 4-year degree from a college or university?

YesNo
Household and Income Information
1. Number of people living in your household?*
2. Do you receive Public Assistance (welfare, social security, food stamps, etc.)?*

YesNo
3. Does your child participate in the free or reduced lunch program at his/her school?*

YesNo
Provide verification of income to include one of the following: current year signed income tax return pages 1 &2, TANF, WIC, HUD acceptance letter, or free or reduced lunch approval form or other forms of government verified income.

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Please upload a copy of your child's birth certificate

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Household Annual Income Verification - Self-Report

NOTICE: Talent Search is required by federal mandate to obtain income information for the household in which the student resides to determine student eligibility. Federal mandate also requires preference to be given to students who meet certain income criteria. Please know this information is kept confidential and only used for eligibility purposes.

Please note that Taxable Income is usually lower than Adjusted Gross Income, which is located at the bottom of the first page of tax forms. Annual Taxable Income can be found on page 2 of most tax forms. Please call the Talent Search office at 512-1464 if you have any questions or need assistance locating this information.
Annual Taxable Income:
By signing below,

I certify that the information provided on this form is true and complete to the best of my knowledge.
Parent's Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy

Personal Essay
The personal essay is an important part of the selection process. In a 250 or more word essay, discuss the following topics: What are your current academic struggles and why are you interested in Upward Bound? How can this program help you accomplish your goals? Please attach additional pages if necessary.*
Additional Pages

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Student's Name

First NameLast Name
Signature*

Clear