St. Mary's University-Judson ISD-UB-Parent Application

Dear Parent or Legal Guardian,
This is an exciting moment, your student has chosen to apply to the St. Mary’s University Upward Bound program! Upward Bound helps high school students from select SAISD and JISD schools become better prepared to succeed in college. Upward Bound participants receive various opportunities, such as college & career exploration, SAT/ACT/TSI prep, financial literacy training, college admissions application & financial aid application assistance, academic tutoring, and more. For more information on our program, you can visit https://www.stmarytx.edu/outreach/upward-bound/ or call us at 210-431-4252.

To finalize your student's application please complete, sign, and submit this form and the required documents.

Required Documents

A copy of your student's birth certificate
A copy of your student's last report card
A signed copy of the last calendar year's IRS Form 1040, Income Tax Return (Ex: If it is the year 2022, submit your 2021 tax form)

Upload Birth Certificate*

Upload Student's Last Report Card

Upload SIGNED copy of the last calendar year's IRS Form 1040 (Income Tax Return) or record of need-based assistance*

Name of Person Completing Form:*

First NameLast Name

Email of Person Completing Form:*

example@example.com

Name of Mother or Female Legal Guardian:*

First NameLast Name

Specify your relationship with the student:*

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mother or Female Legal Guardian Email*

example@example.com

Cell Phone Number:*

(999)999-9999

Work Phone Number:*

(999)999-9999

Occupation:*

Place of Employment:*

Highest level of education:*

Elementary or Middle SchoolHigh School or GEDSome College, No DegreeCompleted Bachelor's degree or Higher

Name of Father or Male Legal Guardian:*

First NameLast Name

Specify your relationship with the student:*

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Father or Male Legal Guardian Email*

example@example.com

Cell Phone Number:*

(999)999-9999

Work Phone Number:*

(999)999-9999

Occupation:*

Place of Employment:*

Highest level of education:*

Elementary or Middle SchoolHigh School or GEDSome College, No DegreeCompleted Bachelor's degree or Higher

What is the total number of persons (including yourself) in your family household?*

What was your family's TAXABLE (not total) income from the last calendar year?*

NOTE: Taxable income can be found on the federal income tax return (Ex: Form 1040- Line 15)

My family did not file a federal income tax return for the last calendar year.

My family's total income from last calendar year was:

My family had no taxable income during the last calendar year.

List all dependents who live in your household and are eligible to be claimed by parents/guardians as income tax exemptions.

	Name	Age	Relationship to Student Applicant	School/Place of Employment
1.
2.
3.
4.
5.
6.
7.
8.

Does your student or your family have any unusual circumstances that you would like Upward Bound to take into consideration?

YesNo

Please explain:

Do you have any other students in high school that you would like to be considered for our program?

YesNo

List any members of your family who have participated in Upward Bound.

	Name	Age	Cell Phone Number
1.
2.

Please provide the name and telephone number of two relatives who know the whereabouts of the student. This information may be used for follow-up and emergency notification purposes.

	Name	Age	Cell Phone Number
1.
2.

The following statement is for parental/legal guardian commitment of support for educational goals, please read carefully.

The St. Mary’s University Upward Bound program must have a positive working relationship with parents and/or legal guardians to achieve its purpose of generating the skills and motivation necessary for participants to successfully complete high school and graduate from college. That is, the St. Mary’s University Upward Bound program and parents and/or legal guardians must become educational partners. Accordingly, the parents and/or legal guardians of students are expected to attend occasional programs, to support their student’s educational goals, and to support their student’s full compliance with the program’s policies & procedures.

Do you agree to be a supportive parent/legal guardian, if your student is selected for the St. Mary's University Upward Bound program?*

YesNo

ELIGIBILITY STATEMENT

I hereby acknowledge that I understand that selection for participation in the St. Mary’s University Upward Bound Program is competitive. I further understand the eligibility requirements and expectations for my student to be considered for participation in the St. Mary’s University Upward Bound program, which includes:

ability to participate in the Upward Bound program until the summer after high school graduation;
ability to demonstrate the academic need for services;
ability to attend instructional and other activities on a regular basis;
ability to demonstrate responsible character;
ability to demonstrate adequate family support for the educational goals of the applicant (including graduation from college);
enrollment in a target high school served by the St. Mary's University Upward Bound program;
between the ages of 13 and 19;
ability to demonstrate U.S. citizenship or status as a legal U.S. permanent resident; and
provision of adequate documentation to verify if family income meets low-income guidelines.

AGREEMENT

I hereby grant permission for my student to participate in all activities required by the St. Mary’s University Upward Bound program if they are selected for participation. I give consent to the high school and district attended by my student to release transcripts to Upward Bound; additionally, I give permission for Upward Bound to obtain high school transcripts (and educational records that pertain to my student's academic progress) upon submission of my student’s Upward Bound application, throughout my student’s high school enrollment and following my student’s high school graduation. I understand that this information is protected by the Family Educational Rights and Privacy Act (FERPA). This information is necessary to determine whether applicants are eligible to participate in Upward Bound and helps the program and the federal government measure the participants' academic preparation. The U.S. Department of Education has the authority to gather information to improve the Upward Bound program.

I agree that my student must fully comply and abide by all policies, regulations, guidelines, codes of conduct, and procedures established by the St. Mary’s University Upward Bound program and that the program reserves the right to withdraw privileges from my student at any time (including discontinuation of participation in Upward Bound). In the event of a dispute, I understand and agree that the decision of the Upward Bound Director is final and may not be contested. As a parent/legal guardian, I will fully support the goals of the
program and agree to help my student to attain these goals. Recognizing that Upward Bound will do everything in its power to supervise participants during project-sponsored activities, I agree to release St. Mary’s University, the Upward Bound program, and its personnel from all legal liability in the event that my student is involved in an accident, injury, or other misfortune. I give permission for the St. Mary’s University Upward Bound program to use my student’s name, statements, and likeness, without charge for promotional purposes in the program’s publications, advertising, video, social media, and other formats.

I further verify that all information reported on this application is true and correct to the best of my knowledge. I agree to provide if requested, any documentation necessary to verify the information reported on this application. I understand and consent for the information reported on this application to be sent to the U.S. Department of Education as Upward Bound is funded by the U.S. Department of Education.

Signature of Parent*

Date:*

mm-dd-yyyy

Upward Bound Pre-College Program Parent Application - JISD