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  • University of Dayton

    TRIO Upward Bound Program

    Student Application

    • Parent Information  
    • (To be completed by the parent)


      NOTE: THIS APPLICATION CANNOT BE PROCESSED WITHOUT THE FOLLOWING DOCUMENTS:

       
      1) Completed Application (with ALL signatures) and materials 

      2) 1040 tax form, or signed and notarized Household Income Verification Sheet

      3) Academic Record- Copy of student’s most recent Report Card

      4) Completed Student Essays  

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    • Medical Information/Emergency Contact  
    • Please list health insurance under which the student is covered: (include medical assistance, if applicable):

    • EMERGENCY CONTACTS (other than persons listed above):

    • ATTENTION: Upon evaluation, we will seek medical authorities for injuries and/or illness that require medical attention.  You will be billed for the costs if your son/daughter requires medical attention while taking part in an Upward Bound activity.  Your signature indicates that you are aware of this policy, and that all medical statements on this form are true and complete.   

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    • Family Information 
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    • Parent Information (Part Two) 
    • Upward Bound Program Household Income Verification Sheet 
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    • Student Information  
    • To be completed by the student 

    • SCHOOL AND STUDENT (Applicant) INFORMATION

    • NOTE: The following questions will not affect an applicant’s eligibility.  They will be used to determine the level/type of support services necessary for the applicant.  Do you:

    • Short Essays 
    • For the Student (Applicant) to complete.   

    • I certify that all of the information given by me to the University of Dayton Upward Bound (UD-UB) Program is true and complete to the best of my knowledge.  I promise to provide whatever appropriate information is requested.  I realize that any misrepresentation of false information on these forms will lead to withdrawal of any offer for my student to join the program, or to later disqualification of my student as a participant in the University of Dayton Upward Bound (UD-UB) Program.  

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