Trident Technical College-UBMS 1-Application Form

New Student Application Form
1001 SOUTH LIVE OAK DRIVE

MONCKS CORNER, SC 29461

(843)899-8019

ubms@tridenttech.edu

In order to be considered for program participation each student must complete this application including: having the appropriate signatures, a completed teacher recommendation forms, most recent transcript, and complete essay question responses.

PowerSchool Parent Portal is a tool that is integrated into the PowerSchool Student Information System (SIS) that is specifically developed for parents and students. The Upward Bound Math & Science Program is requesting access to the Power School Parent Portal information for your child. This access will allow us the opportunity to monitor grades, class schedules, academic progress, attendance, and other information needed in an effort to enhance our advocacy and intervention as it relates to your child's education. We will only use this information for the purposes of keeping accurate accounts of the student's academic progress, to assign tutoring and/or other academic intervention strategies, and to alert student and parent of the need for intervention at the first indication of academic need. By providing this information, you grant us access to your student's Power School information using the credentials you provide in the space below.
PowerSchool Username
PowerSchool Password

Eligibility Confirmation
ELIGIBILITY CONFIRMATION

The parent/guardian with whom you live should complete this section.
Is the student a citizen, national, or permanent resident of the United States?

YesNo
Is the student a ward of the state or emancipated?

YesNo
Mother/Female Guardian

First NameLast Name
Living at Home

YN
Place of Employment
Cell Phone
(999)999-9999
PARENT EMAIL ADDRESS
example@example.com

	Name of School	City	Years Completed	Last Year Attended	Diploma or Degree
Education
Junior/Senior High
University/College

Parent2/Male Guardian

First NameLast Name
Living at Home

YN
Place of Employment
Cell Phone
(999)999-9999
PARENT EMAIL ADDRESS
example@example.com

	Name of School	City	Years Completed	Last Year Attended	Diploma or Degree
Education
Junior/Senior High
University/College

MEDICAL INFORMATION & CONSENT
Name of Student

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
Mother's Employer (If applicable)
Phone #
(999)999-9999
Father's Employer (If applicable)
Phone #
(999)999-9999
Person to contact if we're unable to reach Parent or Guardian:

First NameLast Name
Phone #
(999)999-9999
Relationship of this person to applicant:
Do you have medical insurance?

YesNo
If yes, name of insurance plan
Membership No:
Family Doctor
Phone #
(999)999-9999
List all health problems of which we should be aware.
List all medications your child is presently taking.
List all foods your child should not eat.
List all physical challenges or limitations.
List all learning disabilities.
Are there any religious restrictions that would prohibit emergency health care services of which we should be aware?

YesNo
If Yes, please attach explanation.

Browse Files

Cancelof
Have you ever tested positive for COVID-19 or have any member of your immediate house hold tested positive for COVID-19?*

YesNo
If yes, what was the date of your last negative test results?

MonthDayYear
Date
I hereby grant permission to the Upward Bound Math & Science Center at Trident

Technical College to arrange for needed medical services in emergency situations for {studentName}. I further agree to pay any and all such dental and medical costs, expenses and charges, and do hereby release, discharge and hold harmless the State of South Carolina, Trident Technical College, Upward Bound Math & Science Center, and its employees and agents of any liability of any claim or demand arising from or connected with such medical treatment or care.
Student Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
mm-dd-yyyy

New Student Application Form