Dear Parent / Legal Guardian:

Please find attached to this letter an application for your child to join the Upward Bound Program of Concord University.  Upward Bound, funded by the United States Department of Education, provides unique educational services to qualified students of this area.  It is mandated by congress that two-thirds of the students meet federal income guidelines and that neither parent graduated from a four year college or university.  Students must also show academic need.  Once your child is accepted into the program, all services provided are free of charge.

Following this letter are detailed instructions for completing this application.  Please make sure that all required information and forms are sent to the Upward Bound office, either by mail or via our in school contacts.  Once the completed application is received, we will determine if your child is eligible.  Once we have determined eligibilty we will offer them an interview.

As the Director of the Upward Bound Program, it is my intention to encourage active participation of the parents/guardians in the program.

If you have any questions, please feel free to call the office at (304) 384-5208 or (304) 384-5197.  You may also contact us at the information below.  I look forward to hearing from you.

 

Sincerely,

Andrea Sullivan

Director

Concord University Upward Bound

 

Concord University Upward Bound

1000 Vermillion Street, Campus Box 41

Athens, WV 24712

upwardbound@concord.edu

Upward Bound is a federal TRIO program 100% funded by the U.S. Department of Education.  Grant period of September 2022 - August 2027

Concord University Upward Bound is a Federal TRIO Program funded through the U.S. Department of Education. Acceptance into the program is dependent upon meeting eligibility criteria and space availability. Please answer all questions completely. If a question does not apply to you, complete the question by marking “N/A”. All information you supply will be held in strict confidence.

STUDENT INFORMATION

FAMILY INFORMATION

Father/Male Guardian

Mother/Female Guardian

FAMILY FINANCIAL INFORMATION

I hereby certify that the above information is true and correct to the best of my knowledge.

PRIVACY ACT AND CONFIDENTIALITY STATEMENT/PERSONAL RECORD RELEASE

The personal information you give to Upward Bound is compiled and reported to the United States Department of Education. The information is protected by the Privacy Act. No one may see the information unless they work for the Upward Bound Program or are specifically authorized to see the information. The information is necessary to determine if you are eligible to participate in the program and assists personnel in determining your needs. The Department of Education has the authority to gather information to help make Upward Bound a better program. (20 USC 123 1a)

Great care will be taken to make sure that the personal information collected on Upward Bound students is kept confidential. Any student who wishes to receive the benefits of the Upward Bound Program must agree to submit all necessary information to the Upward Bound Program.

I give my permission to my school(s) to release all grades and records, including an official copy of my permanent record card, discipline summary, achievement, aptitude, and interest scores, standardized scores from 3rd grade up, health data, extracurricular activities, family background information, interview information from school administration, counselors, and teachers, an official copy of my report card for every grading period through University graduation, and a copy of my I.E.P. and /or my psychological evaluation (when applicable). I understand that these records and grades are to be held in the strictest confidence.

AGREEMENT AND AUTHORIZATION FORM

PARENT/LEGAL GUARDIAN AGREEMENT TO PARTICIPATE

I hereby give permission for my child, to participate fully in the Concord University Upward Bound Program. I understand that my child will be required to attend Saturday Sessions and school visits during the school year. I also agree to allow my child to attend the Summer Component of Upward Bound that involves living on the Concord University campus.

STUDENT AGREEMENT TO PARTICIPATE

I understand that the Upward Bound Program at Concord University requires my involvement both during the school year and summer. I hereby agree to attend school visits and Saturday Sessions. I also agree to attend the summer program at Concord University. Furthermore, I agree to abide by the rules and regulations prescribed by the Upward Bound staff. I understand that failure to live up to this agreement may result in my termination from the program.

PARENT & STUDENT AUTHORIZATION

I hereby authorize the performance of medical examination and treatments if an emergency arises as deemed necessary by the physician in attendance. I authorize the attending physician to act as medical judgment may dictate.

I hereby authorize the Concord University Upward Bound Program to transport my child using vans and school buses while participating in Upward Bound activities, to post my child’s name and picture for the Upward Bound website, social media and promotional materials and to allow my child access to the Internet.

THE APPLICANT AND PARENT/GUARDIAN CERTIFY THAT ALL INFORMATION GIVEN DURING ENTIRE APPLICATION PROCESS IS COMPLETE AND CORRECT.

GENERAL MEDICAL REPORT