University Of Illinois-Urbana-Champaign-UB-2022 Application Form

TRIO Upward Bound Application at the University of Illinois at Urbana-Champaign
Dear Applicant:

Thank you for your interest in joining the Upward Bound Program at the University of Illinois at Urbana-Champaign. TRIO Upward Bound is a federally funded program, providing FREE college access services to first-generation, low-income high school students. Since 1966, our Program has provided the tools, resources and training needed to help students be successful in high school and enroll in college.

Students are eligible to apply if they meet the following requirements:
- Potential First-Generation college student and/or
- Low-income (see the income chart under the Income Verification)
- G.P.A. 2.5 on a 4.0 scale (unweighted)
- Complete the 8th grade (may submit application in 8th grade year)
- Attending or will attend Central, Centennial, or Urbana High School
Applications are accepted on a rolling basis. It is important that you complete your application as soon as possible, as there are a limited number of seats in the Program. When space is not available, an applicant will be referred to our waitlist for later consideration.

Once your application is received, please give 2-4 weeks for your application to be processed. You will be notified of your application status. If you have any questions, contact our office at 217-333-1889 or email us at trioupwardbound@illinois.edu.

Sincerely,

TRIO Upward Bound

University of Illinois at Urbana Champaign
Privacy Statement: All information on this application will be held in strict confidence. This information is necessary to ensure that the applicant meets the criteria for admission to Upward Bound as established by the U.S. Department of Education. Information will only be shared with Upward Bound staff for reporting purposes to the U.S. Department of Education.

III. Interest Information
How did you learn about Upward Bound?
Have you ever applied to our program before?
Please select all Pre-College Access programs that you currently participate or have participated in*

AVID (Advancement Via Individual Determination)Talent SearchPrincipal ScholarsI am not participating in another Pre-College Access program

IV. Citizenship
Select your Citizenship status*

I am a citizen of the United StatesI am a Permanent Resident and have a current permanent resident card
Only If you answered No to the above question, please answer the following:
Are you a permanent resident of the United States?*

YesNo
If applicable:
Permanent Resident #:
Date Issued

MonthDayYear
mm-dd-yyyy
If you are not a permanent resident, are you in the U.S. for other than a temporary purpose with the intent of becoming a permanent resident?

YesNo
If you are in the process of becoming a permanent resident, please provide evidence from Immigration and Naturalization Service of your Intent to become a permanent resident.

Cancelof
Briefly provide any additional information, if necessary, regarding your family/living situation (i.e., Homelessness, foster care, recent adoption). If you indicated guardianship above, please note whether this is a court-approved guardianship.

VI. Emergency Contact Information
This is a person who can make decisions for you if your parent/guardian cannot be reached.
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Cell Phone*
(999)999-9999
Relationship to Student*

MotherFatherGuardianSisterBrotherOther
Does this individual live with you?*

YesNo

VII. Parent/Guardian Certification
I declare that the information provided in this application is complete and accurate to the best of my knowledge. I understand that, if selected, my child will be expected to regularly attend all TRIO Upward Bound Program activities including Study Center/Academic Tutoring, High School Visits, and summer programs and participate fully throughout high school until he/she graduates and enrolls in a college or university. I understand that failure to fulfill the required commitment, my child can be terminated from the TRIO Upward Bound Program.
Name of Parent/Guardian*

First NameLast Name
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
mm-dd-yyyy

VIII. Income Verification
Did your parent/guardian file taxes in the last year?*

YesNoUnknown
Do you currently receive or eligible to receive free/reduced lunch through your school?*

YesNoUnknown
How many people, including yourself, are in your family unit?*
Family annual taxable income (must use most recent tax information)*
$ - (Line 15 on Income Tax form 1040, line 27 on Form 1040A)
Per the chart below, does your family identify as low-income?*

YesNoUnknown

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

For family units with more than eight members, add the following amount for each additional family member: $8,070 for the 48 contiguous states, the District of Columbia and outlying jurisdictions.
The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.
The figures shown under the family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The poverty guidelines were published by the U.S. Department of Health and Human Services in the Federal Register on January 17, 2024 and are effective as of January 11, 2024.

This statement confirms my family's income during the calendar year before my student applied for admission to the TRIO Upward Bound Program.
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

IX. Release of Student Information
Media Release
I,*
the parent/guardian of*
do hereby give my permission to TRIO Upward Bound at the University of Illinois at Urbana Champaign to photograph, film, videotape and/or make sound recordings of my child, to quote or publish statements of my child and to use such photographs, films, videotapes, sound recordings and/or other statements in Upward Bound or University educational and promotional/advertising materials and for other purposes specified below.

I understand that my child may be identified in any photographs, news stories or publications that Upward Bound considers appropriate for release to magazines, newspapers, University of Illinois, and the Office of Minority Student Affairs web site, and/or other publications. I further understand that any such photographs, films, videotapes, sound recordings and/or written works are the property of TRIO Upward Bound at the University of Illinois and that neither my child nor I am entitled to any compensation for or rights in these materials.

I release TRIO Upward Bound and the University of Illinois from all liability with respect to the matters covered by this release.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Permission to Release Records
I,*
the parent/guardian of*
permit the release of my son/daughter academic records including but not limited to courses, grades, individual education plans, standardized test scores, and proof of graduation to TRIO Upward Bound Program at the University of Illinois at Urbana Champaign for the purposes of tracking student progress, and compiling and reporting data to the United States Department of Education. I understand that the United States Department of Education requires TRIO Upward Bound at Illinois to report on my child’s academic progress through their graduation from college or for at least six years after my child’s high school graduation.
I,*
the parent/guardian of*
permit TRIO Upward Bound to release of my educational records to my son/daughter respective high school and the U.S. Department of Education for the fulfillment of reporting requirements.
Signature of Parent/Guardian*

Clear
Date*

MonthDayYear
mm-dd-yyyy

X. Personal Statement
Note: Failure to submit the personal statement essays, will result in an incomplete application.

In 250 words or less, please respond to the following questions:
Essay 1- Why do you want to join TRIO Upward Bound?*

0/250
Essay 2- What are your future career plans and how do you plan to achieve them*

0/250
Upload your grades here" to say "Upload your most recent semester transcript or progress report here*

Cancelof
Upload the front and back of your permanent resident card here, if applicable

Cancelof

TRIO Upward Bound Application at the University of Illinois at Urbana-Champaign

Media Release

Permission to Release Records