George C. Wallace Community College-Spark-UB-Application Form
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  • TRiO
    UPWARD BOUND
    PARTICIPANT APPLICATION

     

    SPARKS CAMPUS
    Eufaula, AL 36027-0580
    Phone: 334.619.3011
    Fax: 334.556.2535


    Toll free: 1.800.543.2426, Ext. 4255
    E-mail: trioub@wallace.edu
    Website: www.wallace.edu

     

    Upward Bound Staff


    Kristina Blakely, Director (334) 687-3543 ext. 4204
    Christy Hickerson, Secretary (334) 687-3543 ext. 4255

     

    TRiO Upward Bound is a federally-funded TRIO Program under the U.S. Department of Education that aids students in graduating from college. Program participants must meet certain requirements set forth by the Department of Education. TRiO Upward Bound is committed to providing intensive, supportive, and proactive services that prepare students for a rigorous educational pursuit. TRiO Upward Bound is equal opportunity affiliations and, therefore, does not discriminate on the basis of sex, race, religion, or disability in admission or access to their programs.

     

    Motto: “Inspire to dream more, learn more, and do more” John Q. Adams

  • NOTE: Program participants must meet certain requirements set forth by the Department of Education. The following information will be used to determine your eligibility. All information will be held in confidence by the project staff. PLEASE COMPLETE ALL INFORMATION REQUESTED. (Incomplete applications will not be considered.) PLEASE PRINT!

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    • STUDENT PERSONAL DATA 
    • Are you a U.S. citizen*
    • Gender*
    • Date of Birth
       - -
    • Ethnicity: Hispanic
    • Race:
    • AUTHORIZATION TO RENDER MEDICAL SERVICES 

    • In the event of an emergency, I hereby authorize the physician in charge of the emergency services at a hospital to administer any medical attention deemed necessary or advisable in the diagnosis and treatment of {main_name}

    • Date:
       - -
    • INSURANCE PROVIDER INFORMATION 
    • APPLICATION CHECKLIST 

    • PLEASE USE THIS CHECKLIST TO ENSURE A COMPLETE APPLICATION

      • Complete & Signed Application (Parent and Student)
      • Academic Official/Unofficial Transcript (including all standardized test results)
      • Page 1 & 2 of Parent/Guardian’s Federal Tax Return (COPY) OR Federal TRiO Program Income Verification Form
      • 2 Teacher Recommendation Letters
      • TRiO UB Program accepts participants on a first come, first serve basis. Incomplete applications may result in delaying or denying your acceptance status.
    • DISABILITY INFORMATION 
    • Do you have any documented physical and/or learning disabilities that would require accommodations
    • EDUCATIONAL INFORMATION 
    • Which of the following college readiness assessments have you taken or are planning to take?
    • Have you earned any college credits?
    • Academic Classification:
    • Are you currently enrolled at WCC as a dual enrollment:
    • Do your goals include attending a 4-year college?

    • If you plan to attend a 4-year college. List your top 2 colleges:

    • Have you been part of a TRIO program?
    • Which program (check all that apply)?
    • Are you currently a member of Trio Talent Search?
    • FAMILY INFORMATION & VERIFICATION 

    • All information shared with the Wallace Community College TRiO Upward Bound Program is strictly confidential and is used solely for determining student eligibility for program participation.

      Section A — Family Information

      Enter the information pertaining to the adult(s) with whom the student resides (i.e. parent, stepparent, guardian, other relative).
      Documentation of parental educational background is required for a student to be considered for participation in the TRiO Upward
      Bound Program.

    • Educational Completion (please select one)
    • Does your father currently hold a Bachelor’s and/or Masters degree?*
    • Educational Completion (please select one)
    • Does your mother currently hold a Bachelor’s and/or Masters degree?*
    • INCOME DOCUMENTATION 

    • Documentation of family income is required in order for a student to be considered for participation in TRiO Upward Bound. Please include a copy of the previous year tax returns OR the Federal TRiO Program Income Verification Form.

      Please contact TRiO UB staff to obtain the Federal TRiO Program Income Verification Form.

       

      Section B—Untaxed Income

      If you did not file a tax return or if you received any untaxed benefits, please list the amount shown on your current End of Year Statements for all members of the family. Please provide documentation of any untaxed benefits such as SSA1099 form for Social Security Benefits.

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    • Federal TRiO Programs Low-Income Levels 
    • Size of Family Unit 48 Contiguous States,
      D.C., and Outlying Jurisdictions
      1 $22,590
      2 $30,660
      3 $38,730
      4 $46,800
      5 $54,870
      6 $62,940
      7 $71,010
      8 $79,080
    • PROGRAM PARTICIPATION
    • PARTICIPATION AGREEMENT & RELEASE OF INFORMATION
    • Date
       - -
    • I hereby certify, under penalty of perjury, that my family income

    • exceed the levels listed above based on the size of my family unit. I understand that my family uni t includes myself, my spouse (if applicable) and my dependents. I understand that if I am not married, under the age of 24, not in the military or do not have any dependents of my own,that my family unitincludes myself,my siblings (if any) and my parent(s) from whom I received the most support prior to the age of 18. If I am a ward of the court, my family unit includes only myself.

      I also understand that this is a federally funded program, and that this information is subject to review by Federal authorities if the UB program to which I have applied is audited, and I will be held responsible for the certification made by my signature. I affirm that this information is true and accurate to the best of my knowledge.

    • By signing above, I attest the information contained in this document to be true and accurate to the best of my knowledge.

    • Date
       - -
    • Submit 
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