Dear Parent(s) or Guardian(s):

Your student is being invited to participate in a nation-wide college preparatory program. I cordially invite you to read further and take advantage of this opportunity.

Upward Bound is a federally-funded, college-access program designed to assist low-income and potential first generation college-bound students, who are currently in high school, to pursue post-secondary education upon high school graduation. Students may only be accepted into the program at the end of the eighth-grade or during their ninth through tweltfth-grade years. Once in the program, students remain a participant until high school graduation, must maintain no less than a 2.5 grade point average and are expected to attend services. The Upward Bound Director makes the final decision on whether any student is accepted or continues in the program.

Upward Bound provides Individualized Tutoring services, Classroom Instruction in Math, Science, English, and Foreign Language; a Saturday Enrichment Academy which offers motivational presentations and workshops on a variety of topics, such as college financial planning, career and personality assessment, test taking and study skills, etc. Additionally, college and university tours, student leadership conferences and cultural events are scheduled throughout the year.

During the summer, participants have the opportunity to take Upward Bound enrichment classes at Horry-Georgetown Technical College to prepare them for the next year of study in high school. While the Summer Enrichment Program’s main focus is academic, it also involves a full range of social, cultural and recreational activities.

All Upward Bound services are provided at no expense to participants.  If you would like to be considered for the program, submit the requested items, along with your completed application.

Sincerely,

Joseph Adams, Director
The Upward Bound Program

APPLICATION INFORMATION

When Filling Out Application:

• Be sure to supply all requested information accurately and completely.
• Be sure parent and student sign and date all signature lines.
• Be sure to complete and sign the Confidential Financial Information page regardless of income source.

When Submitting Application:

• Copy of student’s Social Security Card
• Copy of parent’s AFDC, Food Stamp benefits if applicable, Social Security benefits or Unemployment Compensation benefits
• Copy of Tax Return if applicable

Upon receipt of the completed application and copies of the verification documentation, the Upward Bound staff will schedule an interview with student and parent/guardian. Upon acceptance into the program, you will receive a letter or email about status from Upward Bound. All students will participate in New Student Orientation with the parent/guardian.

 

A. STUDENT PERSONAL INFORMATION

B. ACADEMIC INFORMATION

Prioritize the careers or occupations you are most interested in pursuing:

Please list the top three colleges and/or universities you are interested in attending.

C. FAMILY/HOUSEHOLD INFORMATION

D. CONFIDENTIAL FINANCIAL INFORMATION

The United States Department of Education (USDOE) requires that we obtain information from all participants served by the Upward Bound Program. Because the student has indicated an interest in being served by the program, please supply the information requested below. All information will be held in the strictest confidence and records will be maintained according to the USDOE Family Education Rights and Privacy Act (FERPA).

2. Number of people in household (including student):

4. If income taxes were not filed for the previous year, indicate the sources of income* from the previous year:

I certify that the information provided in this application for participation in the Upward Bound Program at Horry-Georgetown Technical College is true and accurate to the best of my knowledge. I understand that falsification or failure to provide correct information is grounds for removal of participation in the program.

E. FREE OR REDUCED LUNCH CERTIFICATION

Dear High School Personnel:
I hereby give permission for information about my child/children be shared with the staff of the HGTC Upward Bound Program to determine initial eligibility and for continued participation during high school enrollment. This information shall include grades, test scores, report cards, and transcripts and participation in the free and reduced lunch program. 

LETTER OF INTEREST

Dear Upward Bound:

Please consider me for the Upward Bound Program at Horry-Georgetown Technical College.

Sincerely,

The United States Department of Education (USDOE) requires that we obtain information from all participants served by the Upward Bound Program. All information requested will be held in the strictest confidence and records will be maintained according to the USDOE Family Education Rights and Privacy Act (FERPA).

• I certify the financial and household information provided in this application for participation in the Upward Bound Program at Horry-Georgetown Technical College given is true and accurate to the best of my knowledge.
• I/we, certify that I/we am/are the parent(s), custodial parent(s), or guardian(s) and that I/we signed this release form for the Horry- Georgetown Technical College Upward Bound Program in the presence of the applicant.
• I understand that if any information is found to be invalid, it could serve as a basis for my child to be dismissed or not considered for the Upward Bound Program.

I/We do hereby authorize the school district to release information from the comprehensive and cumulative school records of my/our child, to obtain documents relative to and consistent with my child’s education such as grades, class, rank, school attendance, school activities, teacher evaluations, standardized test scores, academic performance and forwarding of official transcripts, to bona fide representatives of the secondary schools, accredited colleges, Horry-Georgetown Technical College Upward Bound Program for Upward Bound data collection/ follow-up and general informational purposes. This information can be released when the student who is enrolled in the Upward Bound program is in regular enrollment or when the student has transferred to a new location. This information may be used to determine initial eligibility and for continued participation during high school enrollment. This information shall include grades, test scores, report cards, transcripts, and participation in the free and reduced lunch program.

Such documents may include but are not limited to a copy of school transcripts, report cards, test scores, Power School information and access, ACT, SAT, PSAT, PASS, Individual Graduation Plans (IGP’s), academic, financial, demographic data, information related to my/the student’s application for college admission and acceptance status, financial aid application (FAFSA), and award letter at all colleges and universities, as well as current enrollment status and/or number of credits enrolled. I authorize UB to release or to obtain information from any agency or program providing supplemental educational services. I authorize UB to obtain the above information from my/student’s entry into the program throughout their post-secondary education for completion verification regarding its use only for UB purposes and non-re-disclosure.

I acknowledge and warrant that I am the parent or legal guardian of the identified minor participant; that I have carefully read this document; that I understand its terms, and that I sign it freely and voluntarily. I understand that I am solely responsible for my child’s and/or dependent’s health and safety.

While enrolled in Upward Bound, I promise to - maintain a 2.5 GPA or better throughout my high school tenure.  Demonstrate respect to the Upward Bound staff and peers by honoring all rules, policies, and procedures during travel and on-site locations. Participate in Upward Bound services, such as Classroom Instruction, Tutorials, Saturday Enrichment Academy, and Six-week Summer Enrichment, a minimum of 80% of the time. Contact a member of the Upward Bound staff when unable to attend planned events (843-349-7843). Notify the Program Director, in writing, of any medical limitations that may impact participation. Take the ACT or SAT in the spring of my junior year and beginning of senior year. Complete the FAFSA in my senior year and apply to a minimum of one college.

We (Both Parent and Students) agree to cooperate with the UB program staff in follow-up activities, including the release of needed school records and information throughout high school and college.

To continuously serve students and provide necessary instruction, the Upward Bound program may be providing distance-based, virtual programming for all students. Upward Bound staff will facilitate academic sessions and other activities through online platforms, software, tools, and applications provided by third parties that members, parents/guardians and/or staff will access via the Internet and use for purposes of communication and education. Upward Bound activities may involve group sessions and/or one-one-one meetings with tutors and staff.

To participate in virtual sessions students will need access to the internet as well as a computer, phone, or tablet. They will also need a quiet space to participate in meetings and it is recommended that they are supervised by an adult during this time. By providing consent for participation, you are allowing your child to utilize social media and web-based platforms for distance-based program purposes provided through the Upward Bound Grant of Horry-Georgetown Technical College. 

My signature indicates that I understand that you I/we are solely responsible for my/our child’s and/or dependent’s health and safety and that I/we understand that my/our child’s participation in all virtual programming is voluntary.

My/Our, son/daughter, has my/our permission to participate in the Horry-Georgetown Technical College Upward Bound Program for the summer (June-July-August) and the Academic components (September-May).

I/We will notify the Program Director in writing of any physical, medical, or dental problems my/our child has had that will limit his/her activities.  Additionally, I give Upward Bound personnel permission to access all my health records from the school district.

Parent Participation
I/We understand that for my/our son/daughter to participate, I/we may be asked to participate in Upward Bound activities during the year.

Parent Visitations
I/We understand that I/we am/are always welcome to visit the campus, inspect facilities, observe activities, and confer with the Program Director, Faculty, and staff. For safety reasons, please bring proper identification.

Pick Up/Drop Off of Students
I/We understand that for the safety of my child, he/she can only be dropped off and picked up at the designated Upward Bound locations (Loris – Hardees/Carvers Bay – CBHS).

Consent and Permissions Granted
I hereby give permission for my student to take part in program trips.  I furthermore understand that my electronic signature is the legal equivalent of my manual signature on this and any agreement.

PARENTS AND STUDENTS STATEMENT OF CONFIDENTIALITY AND UNDERSTANDINGS

• Statement of Confidentiality – The personal information you give to the Director of Upward Bound may be sent to the Department of Education. The Privacy Act protects the information. No one may see the information unless he or she works with or for the Upward Bound Program, or is specifically authorized to see the information. The information is necessary to determine if the applicant is eligible to participate in the program and helps the federal government to measure your success. The Department of Education has the authority to gather information to help make Upward Bound a better program. If you do not give this information to the Upward Bound Program and the Department of Education, you cannot receive any benefits from the program.

• We recognize that the Upward Bound Program is a major investment by the U.S. Department of Education, and we understand that if the student is accepted and wishes to attend, he or she will be required to be in attendance the entire academic year (nine months) and summer program period (six weeks). Under very special circumstances, exceptions may be made. Contact the Director if you have any questions/conflicts. Acceptance in the Upward Bound Program is for the duration of the student’s high school education.

• We understand that should students sign up for events, field trips, conferences, etc. and do not show up without officially cancelling within 48 hours he/she may jeopardize their participation in the next field trip. Your 48-hour advance cancellation of your attendance to an event, field trip, conference, etc., assists the program in making good use of funds.

• We agree that photographs of the student taken during the program, papers written by the student during the program, and similar items may be used in reports and public information materials. We further agree to allow Upward Bound to release, for educational and/or promotional purposes, photographs and video recordings, with or without audio, of program activities involving the student.

• We agree to cooperate with the UB program staff in follow-up activities, including the release of needed school records. These follow-up activities will continue throughout high school and college.

CERTIFICATION and AGREEMENT: I(We) hereby certify (1) that I/we have read the Statement of Confidentiality and (2) that the information provided or amended in this application is true and correct to the best of my(our) knowledge.

SUPPLEMENTAL STUDENT INFORMATION

Consent for Medical Treatment
In case of an emergency during participation in Upward Bound activities, it may be necessary for a physician to provide medical care for your child. Such care can be provided only if you sign the following authorization for medical treatment.

I will allow the HGTC Upward Bound Staff to have Consent for Medical Treatment so that they may obtain necessary treatment on my child’s behalf in case of sickness, accident, or other emergency.