Kishwaukee College-UB-Application Form

  • Upward Bound Student Application

  • Thank you for your interest in the Kishwaukee College Upward Bound Program! The Upward Bound Program provides the support and motivation necessary to graduate high school and earn a college degree. Students participate until they graduate from high school and receive all services at no cost.

    Program participants must be a U.S. Citizen or permanent resident and must meet the following criteria:

    • Attend DeKalb High School
    • Completed 8th grade but have not completed high school
    • Be a potential first-generation college student: A student whose parents have not received a bachelor's degree; or
    • Be a low-income student: A student whose family meets federal income eligibility guidelines as determined by the US Department of Education.

    Year-round services offered include:

    • Tutoring in mathematics, science, English, social sciences, and foreign language;
    • Academic, personal development, and college readiness workshops;
    • Career exploration activities and mentoring opportunities;
    • Academic advising and individual assistance with the college admissions and
      financial aid process;
    • College visits, cultural enrichment activities, and special events;
    • A six-week academic summer program on the Kishwaukee College campus.
      Eligibility is determined after a careful review of the New Student Application Form, academic records, recommendation letters, and family interview.
    • Student Information 
    • Date of Birth *
       - -
    • Sex Assigned at Birth*
    • Preferred Pronouns
    • Gender*
    • Are you a U.S. Citizen?*
    • If you're not a U.S. citizen, what is your status?
    • If not, are you a Permanent Resident of the U.S., or have you applied for Permanent Residency?
    • Are you Hispanic or Latino? (OR are you of Spanish origin?)*
    • Are you from one or more of the following racial groups? (select all that apply)*
    • Please identify your primary racial/ethnic group (select one)
    • Check one or more of the following race/ethnicity groups with which you identify:*
    • Current Grade Level*

    • Provide the names and email addresses for two teachers who will be emailed a Teacher Recommendation Form to complete for you (please make sure to tell the person!)

    • Student Short Essay Responses 

    • The student essay is an important part of the selection process because it gives us more insight into who you are. Take time to think about the questions. Create an outline, write a good first draft, and ask your teacher or a friend to take a second look.

       

      In the space below or on a separate typed sheet, please answer the following questions in essay format.

      1. Why are you applying to the Kishwaukee College Upward Bound Program? 2. What are your academic strengths and areas for improvements?
      3. What are your career interests?
      4. Why should we accept you?

    • Parent Information 
    • Student/Applicant lives with (check all that apply)*
    • Highest grade completed in school of Parent/Guardian #1 (living in household)*
    • Has parent/guardian #1 received a Bachelor’s degree?*
    • Has parent/guardian #2 received a Bachelor’s degree?
    • Does the applicant have an Individualized Education Program (IEP)
    • Does the applicant have a physical disability that necessitates specifically designed instructional materials or programs, modified physical facilities, or related services to enable full participation in and access to the program at Kishwaukee College?
    • Do you file taxes for the year 2020 or 2021?*

    • Taxable income is foud on line 15 of the form 1040 U.S. Individual Income Tax Return.

      Taxable income is usually lower than your total income or adjusted gross income.

    • I agree to provide verification of income if requested.*
    • Today's Date*
       - -
    • Authorization to Release Information  

    • I declare, to the best of my knowledge, that the information on this application form is true, correct, and complete. I understand that the Upward Bound program cannot be held liable for any occurrences either during the school year or the summer portion of the program. I agree to the release of information for program publications and press releases.

      I hereby consent release of my secondary and post-secondary academic and student records to the Upward Bound Program. The Upward Bound Program requires my academic information to determine eligibility for admission. Information requested by the Upward Bound Program will include grade and progress reports, attendance and behavioral records, transcripts, standardized test scores, special education records, and related material not otherwise listed.

      I fully understand that the Kishwaukee College Upward Bound Program will request information for only the purposes mentioned above, and that they will observe my confidentiality through the proper maintenance of records in secured files. For more information, contact the TRIO Upward Bound Director, Tijhana Hobson at (815) 825-9437 or trioub@kish.edu

    • Clear
    • Date*
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    • Clear
    • Date*
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    • This information is requested to comply with federal and state laws. Your response will not affect consideration of your application.

    • Is English your native language?*
    • Are you interested in participating in the six-week academic summer academy program on the Kishwaukee College campus*
    • Why Do You Want to Join TRIO Upward Bound - to include self-identified academic need? (Please select ALL that apply)*
    • Were you referred to TRIO Upward Bound?*
    • If Yes, by whom?
    • Who does the student live with?*
    • Is the student a ward of the state?*
    • Does the student reside in foster care or a group home?*
    • In the previous 12 months has the family been homeless?*

    • The applicant is income eligible, based upon the Federal TRIO Programs Current-Year Low-Income chart. For example, a family of four with an annual household income of $39,750 or less after taxes, would check "yes."

      Size of Family Unit 48 Continguous States, D.C., and Outlying Jurisdictions
      1 $19,320
      2 $26,130
      3 $32,940
      4 $39,750
      5 $46,560
      6 $53,370
      7 $60,180
      8 $66,990
    • Yes or No*
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