APPLICATION FOR ADMISSION

The North Alabama Center for Educational Excellence (NACEE) Jackson County Upward Bound (UB) Program is a pre-college program designed to assist and motivate students to successfully graduate from high school, prepare for college admission, and to successfully complete their baccalaureate degree. Upward Bound is a year-round program that offers academic year workshops such as ACT preparation, cultural activities, college tours, college planning, as well as a host of other programs including individualized tutoring and student counseling. Upward Bound also offers a summer enrichment program on the campus of University of Alabama Huntsville (UAH) to prepare students for college life by taking college level classes, as well as experiencing a college life.

I am applying for admission into the Upward Bound program.

Eligibility:

• Have completed 8th grade and are currently in 9th, 10th, or 11th grade
• Reside in Jackson County, Alabama
• Be either first generation to attend college in their family and meet low-income requirements, as defined by the federal government
• Students who are citizens or permanent residents of the United States
• Students who have at least a 2.5 GPA and need academic support
• Be willing to meet daily, Monday-Thursday, after school for tutoring services
• Students who intend to pursue a college education
• Students who complete the application, personal statement and interview process.

Application Requirements:

• Completed and signed application
• Completed personal statement-see question (see below)
• Copy of standardized test scores (GEPA statement)
• Copy of most recent report card
• One letter of recommendation from a teacher or guidance counselor
• Copy of valid photo identification
• Signed copy of applicant’s Social Security card (If you do not have one, please call 800-772-1213 to secure a social security card.)
• Most recent copy of parents' federal income tax return (in a sealed envelope)
• Resident alien documentation (if applicable)
• Completed financial verification form
• Birth certificate

Personal Statement Instructions:

• Question: Why should you be considered for admission into NACEE’s Jackson County Upward Bound Program? How would admission into the program assist you in reaching your goals?
• Must be typed 12pt, Times New Roman font (No more than 250 words or one page)
• Please attach activity sheet (i.e. community service activities, honors and awards)

APPLICANT INFORMATION

FAMILY INFORMATION

Note: The information contained in this application is for the purpose of determining the applicant’s eligibility for NACEE’s Jackson County Upward Bound Program. Information is confidential and will be reviewed only by assigned NACEE staff.

Primary Parent/Legal Guardian Contact

Secondary Parent/Legal Guardian Contact

Parent Information

 

Mother

Father

FINANCIAL VERIFICATION FORM

Note: The information contained in this application is for the purpose of determining the applicant’s eligibility for the Jackson County Upward Bound Program. Information is confidential and will be reviewed only by assigned NACEE staff.

*A foster child or ward of the court is considered a “family of one” and the child’s support payment is considered that family’s income.

Does your family receive assistance from any of the following sources?

If your parent/guardian worked but did not file a federal tax return, you would provide copies of their W-2 statements. Payroll stubs are not acceptable. You must provide documentation of non-taxable income (Welfare, Social Security, Unemployment Compensation, etc.) Copies of letters stating the amount of funds to be received, identification cards, completed unemployment forms, and other documents will be accepted as appropriate verification for consideration for admission to the Jackson County Upward Bound Program.

 

Certification:
I certify that all information provided in this application is true and accurate to the best of my knowledge.

INCLUSIVE ACADEMIC RELEASE

I understand that as part of the Jackson County Upward Bound Program selection process, my child’s school records including transcripts, test scores, and academic progress reports may need to be examined.

I hereby give permission for the release of all academic information pertaining to my son/daughter to the Jackson County Upward Bound Program including, but not limited to, the following information from my child’s high school and future colleges that he/she may attend:

1) School records
2) Transcripts
3) Standardized test scores
4) Information on the student’s status and performance
5) Student’s contact information
6) Warning/Failure notices
7) Registration forms
8) Academic awards

I understand that if my child is selected for the Jackson County Upward Bound Program, the Upward Bound Program will continue to require this information from his/her high school and college. The purpose for collecting this information is to track and evaluate the academic performance of the Programs’ participants and graduates for the entire period of time he/she is enrolled in the Jackson County Upward Bound Program. This consent expires when the participant no longer receives Program services and/or the Jackson County Upward Bound Program is no longer federally mandated to track the participant/graduate’s academic performance.

HIGH SCHOOL/COLLEGE UNIVERSITY INFORMATION RELEASE CONSENT FORM

I, {studentName84}, hereby give permission for the release of all of my academic information to the Jackson County Upward Bound Program including, but not limited to, the following:

1) School records
2) Transcripts
3) Information on the student’s status and performance
4) Student’s contact information
5) Warning/failure notices
6) Registration forms
7) Academic awards

I understand that the Jackson County Upward Bound Program will continue to require this information in order to track and evaluate the academic performance of the Programs’ participants/graduates until the Upward Bound Program is no longer federally mandated to track the participant/graduate’s academic performance. I have been provided a copy of this form.

Jackson County Upward Bound Certification of Application

As the parent/guardian of the applicant, I declare that all information provided in this document is correct and true to the best of my knowledge. My signature certifies that the attached information is correct and that any false or misleading information may result in disqualification of the applicant. I further understand that this information being provided is for the receipt of federal funds.

I hereby authorize the Upward Bound Program in Jackson County to release and receive data regarding my son/daughter to assist my son/daughter with his/her educational planning. My child plans to complete high school and attend a program of postsecondary education, and will need the services of the Upward Bound Program. I hereby grant permission to the personnel of my child's school to release copies of transcripts, test scores, and academic progress reports to the Upward Bound staff.

I understand that if accepted into the Jackson County Upward Bound Program, I must apply for, and if accepted, attend the following mandatory dates:

Monthly Saturday Session	September 2020 - May 2021 (TBA)
Anticipated NACEE Summer Component	June 2021 - July 2021

Photograph & Video Release Form

The Jackson County Upward Bound Program makes every effort to promote the positive activities, honors, and work of our staff and students. This includes working with the local newspapers, radio, and television stations and also developing our own publications. These publications include information, likenesses, and images, which may appear in the local media as well as in other publications.

As we go about this project, there will be opportunities for various students to be interviewed and/or photographed and identified by name and grade or school. However, we understand that some parents may request that we do not identify their child(ren). Please fill out the form below to inform us of your wishes regarding publicity. Please note, your child’s image or likeness may appear in occasional candid photos without any type of name identification and the use of these candid photos of your child is permissible.

I, {parentguardianName108}, give NACEE permission to record the image and/or voice of the minor named below, and I grant NACEE all rights to use these sounds, still, or moving images in any medium for educational, promotional, advertising, or other purposes that support the mission of the Jackson County Upward Bound program. I agree that all rights to the sound, still, or moving images belong to the Jackson County Upward Bound Program.

MANDATORY PROGRAM REQUIREMENTS

Uniform Requirement (See Dress Code Policy in manual)

As detailed in the 2018 Summer Manual, students will be required to adhere to a uniform dress code. NACEE Jackson County Upward Bound will provide one t-shirt at no cost to you.

Email Requirement

All students & parent/legal guardians must obtain Google email accounts “Gmail” for direct line of communication between the program participants and their families.

You may use an existing gmail account, but it is preferred for you to include your name within the email address. Additionally, please provide one alternate email address that you check regularly.

Student:

Parent:

PERSONAL STATEMENT