Kankakee Community College-UB-Application Form

Total number of people living in your household including yourself*

Please check the box that corresponds with the range in which your household's taxable income falls for the most recent tax year. If you filed taxes, taxable income is reported on line 10 of the 1040 tax return.*

If you selected "Did Not File" in the previous question, please report your income for the previous year.

Kankakee Community College's Upward Bound program is fully funded by the U.S. Department of Education.

By signing this application, you certify that the information submitted is correct. You understand this information is strictly confidential and will be maintained in the Upward Bound office at Kankakee Community College.

Student Signature*

Kankakee Community College's Upward Bound program is fully funded by
the U.S. Department of Education.

By signing this application, you certify that the information submitted is
correct. You understand this information is strictly confidential and will be
maintained in the Upward Bound office at Kankakee Community College.

I acknowledge the income information provided on this form is true and
correct. I understand that I may be required to submit a signed copy of my
U.S. tax return to prove income, as required by the Department of
Education. If I fail to provide this documentation, I understand the applicant
may not be accepted into the program.

I authorize my child's high school to release high school transcripts, test
scores and grade reports.

Parent/Guardian Signature*