I, the student, confirm my interest in participating in the Upward Bound program at Bloomsburg University, with my typed signature below.

I understand that Upward Bound is an academic, college preparatory program, and students who are selected for the program are expected to work diligently toward the goal of attending college, preferably with the goal of earning a bachelor's (four-year) degree, immediately after graduating from high school.

If accepted, I pledge to attend after school meetings held at my school (in person or virtually) during the academic year on a regular basis. If I am unable to attend a meeting due to my participation in another school-related activity, I will notify the Upward Bound staff or the center coordinator in advance. I understand if I fail to attend Upward Bound meetings or events regularly, my participation in the program might be in jeopardy.

I will attend occasional on-campus events, including the annual Fall Kickoff (beginning of the year orientation event), Summer Academy information days (if I plan to attend the Summer Academy), TRIO Day (community service) events, and the Senior Sendoff (graduation event), as required.

I understand that I will be expected to attend at least one Summer Academy during my time in Upward Bound.

I understand that Upward Bound will offer numerous opportunities for me to visit and learn more about area colleges and universities. I understand that per-registration for these trips will be required since spaces may be limited.

I will enroll in rigorous, challenging courses and do my very best in them in order to prepare academically for success in college. I understand that Upward Bound will monitor my grades each marking period and expect to see some effort in sustaining or improving my cumulative grade point average and individual class grades.

In preparing for college, I understand I will be expected to complete certain requirements for Upward Bound, depending on my grade level. As a junior and senior I will be expected to take the SAT or ACT and provide Upward Bound with copies of my scores. As a senior, I will be expected to apply for admission to at least four colleges and universities, including Bloomsburg, and will provide copies of my acceptance letters to the program. I will also need to submit the Free Application for Federal Student Aid (FAFSA) and provide verification that I have completed it.

I understand that I will receive a stipend during the academic year and the summer. The amount of my stipend will be based upon my attendance and participation at program meetings and events along with my grades.

I understand that Upward Bound will have high expectations for me, and I am prepared to do my best in meeting them. I will let the program staff know if my email, phone number, or mailing address changes, and I will maintain regular contact with them through face-to-face meetings, email, phone calls, or texts if I encounter situations that make it difficult for me to participate.

I understand that my future college enrollment and degree attainment are important for sustaining the program and ensuring it is available for students in the future. I further acknowledge that Upward Bound's services, including trips and everything for the Summer Academy, including my housing and meals, is provided free of charge, thanks to Upward Bound's federal funding.

THIS SECTION SHOULD BE COMPLETED BY A PARENT OR GUARDIAN.
Please note that Upward Bound is required by federal law to collect information on the educational attainment of applicants' parents/guardians as well as household taxable income in order to determine whether or not students are eligible for the program. This information is not reported to any source, is treated confidentially, and is only reviewed in determining your student’s eligibility for the program

I, a parent/guardian, give permission for the student in my care to participate in the TRIO Upward Bound program at Bloomsburg University.  I further attest that all information regarding income and educational attainment provided in this application is accurate and true to the best of my knowledge.

I understand that the purpose of the Upward Bound program is to assist students in preparing to successfully complete a program of postsecondary education.  To contribute to this effort, I, the parent/guardian, commit to supporting and encouraging my student’s participation in all aspects of the program, including the academic year and Summer Academy, until graduating from high school.  I will encourage my student’s compliance with all rules, regulations, and program requirements, and understand that his/her failure to comply could result in dismissal from the program.

I hereby give permission for my student to travel in a vehicle operated by an Upward Bound staff member or contracted by the program and release Bloomsburg University, Upward Bound, and all program staff from all liability related to accidents and injuries.

I hereby give permission for photos and videos of my student to be used in Upward Bound’s community and campus press releases, newsletters, videos, web sites, social media sites, and recruitment materials.  I understand this permission may be withdrawn at any time through submitting a written request to the program’s director.

I authorize my student’s school district to release disciplinary records, report cards, transcripts, progress reports, free and reduced lunch applications, Individualized Education Plans (IEPs), and standardized test scores (including Keystone, PSSA, PSAT, SAT, and/or ACT scores) to the Upward Bound program from this point forward and authorize Upward Bound staff to access my student’s online school record management system.  I authorize any college/university where my student/I enroll to release my transcripts to the Upward Bound program for tracking and program follow up purposes.  Lastly, I give permission for the TRIO Upward Bound staff to contact school administrators, counselors, and Intermediate Unit staff regarding my student and his/her needs and authorize the full release and exchange of all information concerning my student. 

With my signature below, I agree to everything listed above and verify that the information provided throughout this application is true and accurate to the best of my knowledge.