Mercer University Upward Bound - Bibb PROGRAM APPLICATION

If yes,

Upward Bound (UB) Student Commitment

All of us have dreams – of what we want to be, as we grow older, what we hope to achieve for ourselves and how we can make a positive contribution to society. In the questions below, tell us what you hope to accomplish in your life with the help of Mercer University Upward Bound, and how that relates to you moving forward to college.

If selected as a participant in the Mercer University Upward Bound Program, I agree to make a commitment to participate in the entire program and conduct myself in a manner that will bring credit to myself, my family, my school, my community and the Mercer University Upward Bound Program.

I understand that my attendance is extremely important for my success with Upward Bound. Therefore, should I be admitted, I agree to ensure my attendance and active participation in tutoring (at least one day per week), Saturday Academy (monthly), summer courses (6 weeks), meetings (weekly or as needed) and activities sponsored by Upward Bound. I understand the Mercer Upward Bound Student Participation Guidelines and agree that I must meet minimum participation requirements or jeopardize my program enrollment.

I will comply with all rules and regulations of the Mercer University Upward Bound Program, and I am aware that failure to comply with the rules and regulations as well as the failure to fulfill the commitment to the program could result in dismissal from the program.

I understand this information is protected by the privacy act and that no one may view this information unless they work with or for Mercer University Upward Bound or are specifically authorized. This information if necessary to determine my eligibility to participate and I certify that the above information is accurate to the best of my knowledge.

Information Release: I would like to be part of the UB program. I authorize the Mercer University Upward Bound (UB) to obtain documents information relative to and consistent with my education. Examples of these documents may include and are not limited to a copy of my school transcript, test scores, ACT/SAT or GED scores, attendance records, disciplinary reports, and school lunch program eligibility. I authorize UB to obtain information related to my application for receipt of student financial assistance (federal, state, or other), a copy of my award notification from the financial aid office, college admission acceptances and registration information. I give my college of attendance and National Student Clearinghouse permission to disclose my college enrollment status and degree attainment data to the Mercer University Upward Bound staff for the purpose of tracking my college enrollment and completion. I hereby give my permission for my name, photograph, work, and/or statements to be used by Mercer University for promotional, publicity (web pages, social media, brochures, newspaper, etc…), or instructional purposes.

Tell us what services you need from Upward Bound to ensure that you graduate from high school ready to enroll in and be successful in college. Check all services that you think will assist you in being successful.

Father/Guardian

Mother/Guardian

The financial information requested is required by the US Department of Education to determine your child’s eligibility for Upward Bound. Please be advised that the program may request additional documentation.

I understand that the purpose of the Mercer University Upward Bound Program is to prepare participants to successfully complete a program of post- secondary education. As part of my personal effort in this preparation, should my child be admitted to the program, I commit to Upward Bound and intend to participate in all academic year and summer program activities organized and sponsored by the program for parents.

I further understand that my and my child’s attendance and participation is extremely important. Therefore, should my child be admitted, I agree to ensure his/her attendance and active participation in tutoring (once a week), Saturday College (monthly), summer courses (6 weeks), meetings (monthly and as needed) and activities sponsored by Upward Bound. I understand the Mercer UB Student Participation Guidelines and agree that my child must meet minimum participation requirements or jeopardize program enrollment (refer to attachment).

I will comply with all rules and regulations of the Mercer University Upward Bound Program and I am aware that failure to comply with the rules and regulations as well as the failure to fulfill the commitment to the program could result in my child’s dismissal from the program.

I have read and understand my commitment to meeting the expectations of the Mercer University Upward Bound Program.

Information Release: I would like my child to be a part of the Mercer University Upward Bound Program and hereby give permission for my child to participate in all activities. I/we authorize the Mercer University Upward Bound (UB) to obtain documents information relative to and consistent with my child’s education. Example of these documents may include but not limited to: a copy of my child’s school transcript, test scores, ACT/SAT or GED scores, attendance records, behavior report, and school lunch program eligibility. I/we authorize UB to obtain information related to my child’s application for receipt of student financial assistance (federal, state, or other), admissions acceptances and registration information. In addition, I hereby give my permission for my child’s name, photograph, work, and/or statements to be used by Mercer Upward Bound Program, for promotional, publicity (web pages, social media, brochures, newspaper, etc…), or instructional purposes.

I attest to the fact that all information in this application packet is true and accurate to the best of my knowledge.

We must also review your academic progress. Please send an evaluation form request to your English teacher or Mathematics teacher to complete in 5 days. The application file is not complete and a decision on admissions will be not be made until this form is submitted. The application is not completed until received.