Boise State University-UB 4-Application Form

Boise State University TRIO Upward Bound - Student Application
Upward Bound (UB) is a federally funded program from the US Department of Education to encourage first-generation, limited-income students to further their education. Services include · college and career exploration · study skills · financial aid assistance · college campus tours · service learning · instruction/tutoring in academic subjects · academic advising · a six week residential summer program on the Boise State University campus · opportunity to earn cash for participation. All Upward Bound services are free to the student and family.

All information provided on this application will remain confidential!
Missing documentation and/or incomplete applications will delay processing and student services.

Teacher Recommendation
TEACHER RECOMMENDATION

Please provide us the names of two teachers who can tell us about you. List their names and contact information below.
Teacher Name*

First NameLast Name
School*
Name of Class*
Teacher Name*

First NameLast Name
School*
Name of Class*

Writing Sample
WRITING SAMPLE

Answer the following two prompts:
1) What is important for us to know about you? Include your hobbies, talents, what you like to do in your spare time, your experiences with school, your favorite classes, information about your family and how your friends would describe you. This is an important part of the application, so be sure to do your best.*
2) As an Upward Bound student, you are making a commitment to enroll in the Upward Bound class during your high school career and attend the Upward Bound six-week residential summer program at least once. These two components are mandatory for students who wish to participate in Upward Bound. Please discuss why the classroom and summer program components of Upward Bound would be an excellent opportunity for you.*

Certification and Signatures

Certification and Signatures*

	Please check each box after agreeing to each statement:
I/We certify that the information provided on the application is true and correct to the best of my/our knowledge.
I/We certify that the information provided concerning citizenship is accurate.
I/We authorize the release of my school records (transcripts, standardized test scores) to the TRIO UB program.
I/We consent to the disclosure of any personally identifiable information as defined by FERPA of my education records to the Boise State University TRIO Upward Bound program staff for the purpose of confirmation of my postsecondary enrollment status as reported on the National Student Clearinghouse Student Tracker. This authorization will remain in effect for six years following my high school graduation.
I/We authorize the release of my school and free/reduced lunch records to the TRIO UB program.
I/We authorize the release and exchange of student financial aid information from colleges and federal government to the TRIO UB program.
I/We authorize the release of college enrollment status to the TRIO UB program for up to six years after graduation.
I/We understand that there is a zero tolerance policy with regards to blatant or implied gang insignia, dress, hand signs, harassing or threatening behavior, weapons, alcohol, and drugs.
I/We understand that the completion of this application does not guarantee acceptance in the TRIO UB program.
I/We understand that the information provided on this application will be held in confidence by the TRIO UB program.
I/We authorize the use of my image in TRIO UB publications and media releases to the TRIO UB program.
I/We authorize TRIO UB to transport my son or daughter as the situation arises if no other transportation means are available and after the TRIO UB staff person has contacted or has attempted to contact the student’s parents or guardians.
I/We understand that if I need accommodation for a disability to participate in TRIO UB, or any of its scheduled activities, I/we must contact Upward Bound at (208) 426-2318 at least 30 working days prior to the activity.
I/We understand that I may utilize computer and other electronic resources, including internet access, as part of my participation in Boise State TRIO Upward Bound program. When utilizing these resources, I acknowledge that I am still bound to my school's Technology Use Policies as well as additional policies Boise State University may require.

Student Signature*

Clear
Date Signed*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature*

Clear
Date Signed*

MonthDayYear
mm-dd-yyyy

Boise State University TRIO Upward Bound - Student Application