Pasadena City College-UB 2-Application Form

Dear PCC Upward Bound Applicant,

We’re so excited that you’re interested in joining the Upward Bound Classic Program at Pasadena City College. Our program is offers educational resources and support for student participants including tutoring, college application assistance, cultural activities (field trips and college tours, personal development workshops, college advising and stipends! Currently, our program is offering virtual interactions only! We hope to be back to in person student interactions very soon!

Student Eligibility for Upward Bound is as follows:
- Must be a low-income individual and/or a potential first-generation college student
- Must be enrolled at one of the following high schools
  - Pasadena USD – Blair HS, Marshall Fundamental, Muir High School, Pasadena High School
  - El Monte UHSD – Arroyo High School, Rosemead High School
The program offers the following services to eligible participants:
- Tutoring and Mentoring
- Saturday Academy – Supplemental academic instruction and tutoring
- Enrichment Activities – College visits, educational/cultural trips, college awareness and financial literacy workshops
- 6 Week Summer Component Program (6 Weeks) – which include academic enrichment, residential component at Cal State Fullerton and a Summer College Tour (Northern CA or San Diego) and class instruction and tutoring English, math, science, and foreign language
- Academic Advising and Mentoring
All information provided will be kept strictly confidential.

Contact the Upward Bound Office if you have any questions and/or need assistance.

UpwardBound@pasadena.edu or 626-585-7696

Application Checklist
Application Checklist:
- Student Information
- First Generation Verification
- Income Verification
- Questions to be Completed by Applicant
- Personal Statement
- Release Form
- Letter of Recommendation Form Request
- Transcripts Upload
  - Middle School Transcripts – 8th grade applicants only
  - High School Transcripts – 9th – 12th grade applicants only

Family Income Verification
How many people are living in your household?*
Family’s Annual Income*
(Federal Tax Form-1040/A p.1)
Parent's Initials*
(Verification)
Taxable Income*
(Federal Tax Form-1040/A p.2)
If you did not file an income tax return for the most recent year, please indicate your source(s) of income by checking the appropriate box(es) below:

Social SecurityVeteran's BenefitsUnemploymentChild SupportPublic AssistanceDisabilityOther
Parent's Initials*
(Verification)

Student Questionnaire
Are you currently enrolled in any of the following programs:*

Educational Talent SearchUpward BoundUpward Bound Math and ScienceCal SoapAVIDI am not in any of these programsOther
Are you interested in attending college?

YesNo
What Career are you interested in pursuing?*
What school and community clubs, sports or volunteer activities are you involved in?*

Student Personal Statement
Why are you interested in joining Upward Bound at Pasadena City College? What do you hope to gain from joining the program?*
Please share the name of up to two teachers, mentors, counselors or advisors who would be willing to share a letter of recommendation on your behalf. We will email them our recommendation form on your behalf.
Name*

First NameLast Name
Email*
example@example.com
Name

First NameLast Name
Email
example@example.com

Acknowledgement and Consent
PARENT/GUARDIAN ACKNOWLEDGEMENT AND CONSENT:
- I hereby authorize the Upward Bound Classic Program at Pasadena City College to request and obtain academic transcripts and other academic cumulative records for the above -named student from their respective High School. Information may contain high school graduation requirements: credits completed and credit deficiencies; grade point average (GPA); college admission test scores such as ACT and SAT; and other information necessary to properly provide services.
- I understand that by signing this form, permission is granted to use photos of the participant on the program’s social media, brochures, publications and website.
- I understand the purpose of the Upward Bound Program, which is to prepare participants to successfully complete a program of postsecondary education, and I would like to have my child participate. I agree to be involved in the following ways: (1) staying informed of my child’s progress in school; (2) encouraging my child to attend all UB activities and to follow Upward Bound Policies; (3) participating in UB events in which parents are invited; (4) sharing concerns about my child’s education with UB staff.
- I certify that all the information provided in this application is accurate. I understand that the Upward Bound Program may deny or rescind my child’s admission if any information is found to be incomplete or inaccurate
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Print Parent Name*

First NameLast Name
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy