Central Arizona College-UB-Application Form

Dear Applicant:

Thank you for your interest in the Central Arizona College Upward Bound program. Upward Bound is a college preparatory program funded by the U.S. Education Department. The nationwide program was established in 1965 under the administration of President Lyndon B. Johnson.

Its goal is to help high school students who meet certain criteria be successful in high school and to obtain a postsecondary degree by providing academic enrichment, cultural field trips, tutoring, guidance and counseling.

The Upward Bound program has already helped thousands of students earn a college degree and improve the lives of students and their families. A world of opportunities awaits you with Central Arizona College Upward Bound!

Criteria for enrollment in the program include:
- meeting federal income eligibility levels
- being a potential first generation college student (where neither parent nor guardian holds a bachelor's degree)
- commit to preparing themselves for post-secondary education before being accepted into the program
- attend a 6-week academy each summer
- currently enrolled at Coolidge High School, Vista Grande High School or Casa Grande Union High School
The Upward Bound program includes a Fall and Spring schedule of activities at your high school and at the Central Arizona College Signal Peak Campus. A mandatory six-week summer program offers enrichment classes and field trips on weekdays in the months of June and July.

The program may include classes in Reading, Writing, Math, AzMERIT, PSAT/SAT/ACT test preparation, science, foreign language, and other courses in specialized fields. Upward Bound will take students to visit college and university campuses throughout the state of Arizona.

We will review your application and contact you as to your status and next steps in the application process. Remember, you only need motivation, dedication, and a desire to succeed. Upward Bound will help you with the rest.

We look forward to hearing from you. If you have any questions about the forms, please call the Upward Bound office at 520-494-5114 or talk to your high school representative.

Sincerely,

April V. Ortega
april.ortega@centralaz.edu
Program Director, Upward Bound

Marcela Hernandez,
marcela.hernandez@centralaz.edu
Advisor, Upward Bound

Personal Essay
The personal essay is an important part of the selection process. In a 100 or more word essay discuss ONE of the following topics: Please attach additional pages if necessary.
1. What are your goals for college after you graduate from high school?
2. How are your current choices and decisions potentially affecting your life after graduation?
3. What events or persons in your background have influenced you in your educational and career goals?
Personal Essay
Additional Page Upload

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Release of School Records
I authorize the Upward Bound Program of Central Arizona College to access and/or receive copies of my student’s academic transcripts, grade reports, report cards, AzMerit scores, and any other academic information and test results necessary to complete the program’s application process.
Parent's/Guardian's Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
Student's Name

First NameLast Name
Social Security #*
999-99-9999
The Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. §1232g, are respectively federal and state laws providing for the review and disclosure of student educational records. Central Arizona College Upward Bound TRIO program will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent of the student, except as authorized by FERPA.

Talent Release Form
I agree to allow Central Arizona College and its agents to photograph, videotape, and/or record me (and/or my children) and to use such content containing my likeness (and/or the likeness of my children) in college marketing materials including (but not limited to) the following mediums for transmission throughout the universe, as deemed necessary by the Central Arizona College Public Information & Marketing Office, or its agents:
- college publications
- promotions
- public newspapers
- magazines
- advertisements
- billboards
- websites
- radio
- and/or any other publicity mediums that currently exist, or that may be invented in the future
It is expressly understood that Central Arizona College retains exclusive ownership of the intellectual property and duplication rights to the content that contains my likeness, (and/or the likeness of my children).

I agree to grant exclusive royalty-free rights to Central Arizona College and its agents to use the aforementioned materials containing my likeness (and/or the likeness of my children) with no limitation and no expectation of remuneration.

I agree that I am 18 years of age, or older, or that my parent or guardian has granted permission to use my likeness in college promotions.
Printed Name of Recorded Person

First NameLast Name
Signature of Recorded Person*

Clear
Signature of Parent or Guardian (if Recorded Person is under 18)*

Clear
Date

MonthDayYear
mm-dd-yyyy
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
(999)999-9999
E-mail address
example@example.com