Indian River State College Upward Bound Application

TRIO UPWARD BOUND
INDIAN RIVER COUNTY
INDIAN RIVER STATE COLLEGE
6155 College Ln - Building B123
Vero Beach, FL 32966
Telephone: (772)226-2680
ubirc@irsc.edu

The TRIO Upward Bound Program (TRIO UB – IRC) is a 100% federally funded program by the US Department of Education, designed to encourage students in grades 9-12 to complete secondary school and explore college and career opportunities.

The ultimate goal of the TRIO UB – IRC Program is to assure that our participants graduate from high school, apply and enter the college of their choice, secure financial aid/scholarships to pay for their college education, and graduate with a postsecondary educational credential.

AM I ELIGIBLE?
TRIO Upward Bound

• Be a U.S. Citizen or *Permanent Resident Alien
  • *A copy of permanent residency card must be attached
• Be at least 13 years of age and grades 9-12; a rising freshman the summer after
• 8th grade completionAttend Indian River Charter HS, Sebastian River HS, or Vero Beach HS
  • OR Live in Indian River County
• Qualify as Low Income and/or Potential, First Generation College Graduate and/or In Need of Academic Support and Advising

PROGRAM BENEFITS

Assistance with Scholarship Applications
Assistance Applying for Federal Financial Aid (FAFSA)
College Tours and Cultural Field Trips
Assistance Applying for College Admissions
Career Exploration Activities
Assistance with Financial Literacy Education
Academic Advisement
College Awareness Activities
SAT and ACT Waivers
SAT and ACT Prep
College Application Waivers
Tutoring Services
Summer Program
Advising and Mentoring

HOW DO I APPLY?

1. Complete all sections of the Application (pages 1-3), along with your Counselor and Teacher Recommendations Forms.

Electronic Application: Complete the electronic application, you do not have to submit a paper form if the application is completed and submitted electronically.

Paper Submission: You may print and turn in the application to the TRIO Upward Bound office or mail to the following: IRSC Mueller Campus, ATTN: TRIO Upward Bound, 6155 College Ln, Room B123, Vero Beach, FL 32966.

Paper Submission: You may print and turn the application in to your school counselor.

EMERGENCY CONTACT INFORMATION

Family Income

(Effective January 12, 2022 until further notice)

 

The Family Educational Rights and PrivacyAct of 1974prohibit the disclosure or release of privileged and confidential information. All information obtained by Indian River State College Upward Bound-Indian River County office remains confidential.

Questions for Student:

Health & Wellness Center
MEDICAL CONSENT FORM

Dear Parent or Guardian:
IRSC’s Health and Wellness Center provides student health care services under the supervision of a registered nurse. It is necessary for you to sign this form for your child to receive student health care if he/she is under the age of 18. Parents will be responsible for the updating and notifying IRSC’s Health and Wellness Center, Upward Bound Director and Academic Coordinator of any changes authorizing the appropriate treatment for your child. Your signature below authorizes the appropriate treatment for your child, which may include:

1. First Aid Care.

2. Treatment of health problems (stomachaches, earaches, headaches, cuts, sores,  colds, coughs, ringworms, etc.).

3. Minor Emergency Care.

Your signature on the line below indicates you consent for treatment:

Please sign below if you do not want the health team to provide any services to your child.

If you have any questions, please contact the Health and Wellness Center at 772-462-7825

RELEASE & AUTHORIZATION

RELEASE OF ACADEMIC RECORDS AND INFORMATION
I authorize the release of school records for the applicant’s file that may be requested by Upward Boundat Indian River State College. I understand that the U.S. Department of Education funds Upward Bound and will use these records to provide academic advisement and other services. I also understand that these records will be handled in a confidential manner and that they will be made available only to program staff and representatives from Federal and State Departments of Education. I release the following information from public school records to the Upward Bound program: transcripts, test scores (TABE, PERT, ACT/SAT, Academic History, etc.), report card grades and progress reports, information concerning disciplinary actions, attendance record 9th-12th, income and other information necessary to the program for application completion, to provide academic support, and verification of student progress. All information provided on this form will be kept confidential and will not be disclosed to a third party by the program without my permission. I understand that I as the parent/guardian will be required to disclose information, such as household income, necessary to determine my eligibility for the program participation.
Note: A photocopy of this record release form should be accepted as an original and the date of the application has no bearing when the Indian River State College TRIO Upward Bound Program requests the information.

MEDICAL AUTHORIZATION
If medical services are needed by my child while participating in the Upward Bound program or on field trips, I give my permission for my child to receive any medical services deemed necessary.

ACTIVITY AND FIELD TRIP AUTHORIZATION/RELEASE
As the parent/guardian of the applicant I do willingly execute this release in consideration of the educational benefit to be derived by my child in participating in TRIO Upward Bound, a College sponsored activity. I hereby release from liability and hold the College harmless from any and all claims and causes of action which might be brought by my child for loss of property, personal injury or death sustained by my child arising out of travel or activity conducted by or under the control of the College. I understand that the term “College” as used herein shall include the employees, administrators, agents, and Board of Trustees of the College.

PHOTO RELEASE
I hereby grant Upward Bound at Indian River State College permission to photograph/video my child and/or to use their likeness in photograph(s)/video in any and all of its publications and in any and all other media, whether now known or hereafter existing, controlled by Upward Bound at Indian River State College, in perpetuity, and for other uses by the College or Program. I will make no monetary or other claim against TRIO Upward Bound at Indian River State College for the use of the photograph(s)/video.

COMPUTER USAGE
I grant permission for my child to access networkedcomputer services such as the Internet, WorldWideWeb, and electronic mail.

By signing, I hereby acknowledge and certify that the information contained in this application, and any attached supporting documentation provided, is true and correct.

Student Agreement

I agree to participate in TRiO Upward Bound as outlined in the requirements listed below

1. I realize that TRiO Upward Bound is a program brought to my community for important tasks. I will respect, appreciate the program and value my education.
2. I agree to regularly attend the after-school and Saturday programs. I understand TRiO Upward Bound defines regular attendance as having no more than three unexcused absences during each nine-week grading period. I will communicate with TRIO Office Staff about my attendance.
3. I agree to attend college advising sessions and other scheduled appointments with the program staff. Advising will be provided to assess academic progress, college preparation and objective achievement. I understand that I will be notified of advising sessions/appointments and that attending is my responsibility. I will communicate, call and/or reschedule all appointments that I am unable to keep.
4. I understand that I may be placed on academic probation if my grade point average (GPA) drops below 2.7. If my GPA does not improve, I may be suspended or terminated from the program. Reasonable student progress in course work is the basic objective of TRiO Upward Bound. I understand that I may be suspended or unable to attend “reward trips/activities” if the effort to make progress has not been made (documented by progress reports, report cards, classroom attendance, grades, test scores, etc.)
5. I understand that after acceptance in the TRiO Upward Bound program, if I enroll in a lower-level course at my high school without academic advising from the program Academic Coordinator, Counselor or Director, a student/parent conference may be scheduled. GOAL: I will enroll in upper-level, rigorous courses to increase my educational opportunities, when possible.
6. I agree to being placed in tutoring each semester of TRiO Upward Bound based on my performance and I understand that tardiness will not be tolerated, and will make every effort to arrive on time.
7. I understand that I may participate in two (2) extracurricular activities during the academic year. Participation in more than two activities requires approval from the TRiO Upward Bound Program. TRIO should be treated as a priority and attendance is important. I will be responsible and turn in all practice and game schedules, as well as, work to document the purpose of missed events.
8. I understand that individual and group testing (pre and post diagnostic assessments, PERT Placement Test, SAT, ACT review testing, etc.) is mandatory to determine academic, vocational and personal needs.
9. I will attend field trips to cultural and educational functions throughout the year. Examples of activities may include but are not limited to plays, lectures, dinner theaters, growth workshops and visits to museums, colleges and universities, sports events and science and research institutes. These activities may or may not be sponsored by TRiO Upward Bound.
10. I understand if my cell phone is a distraction, I will be asked to put my phone away and understand it may be taken until the end of the event/activity if I continue to be distracted after a warning from a TRIO staff member.
11. PHOTO RELEASE: I give TRiO Upward Bound permission to display my photo at college-sponsored activities. I hereby release
    from liability and hold the College harmless from any and all claims and causes of action that might be brought by any party.
12. I understand that any personal property left behind by me or any others are not the responsibility of the TRiO Upward Bound program.
13. I am aware that if selected for the TRiO Upward Bound summer program, I am obligated to also follow the same the rules listed.
14. I do understand that this is a grant funded program, and I may be asked to participate in follow-up studies up to six (6) years after my high school graduation date.
    
    MAJOR BEHAVIORS – NO TOLERANCE
    
15. I understand that I am subject to disciplinary actions up to and including termination from the TRiO Upward Bound program if I possess, transmit or am under the influence of alcohol or of any kind of intoxicant or drug not approved by the program before, during or after program hours, at any program function or IRSC event. This includes the sale or delivery of any device, contraband or paraphernalia intended for administering these products.
16. I understand that if I knowingly possess, handle or transmit a firearm of any kind, including but not limited to rifles, shotguns or fireworks, I will be subject to disciplinary actions up to and including termination from the TRiO Upward Bound program.
17. I understand that if I am involved in stealing, damaging or destroying school/private property or improper computer usage during or after program hours or at any program function or event, I will be subject to disciplinary actions up to and including termination from the TRiO Upward Bound program.
18. I understand that if I refuse to give my name to a staff member or make threats against any staff member or am disrespectful or disobedient to a staff member, I will be subject to disciplinary actions up to and including termination from the TRiO Upward Bound program.
19. I understand that if I leave the Mueller Campus, or any TRiO Upward Bound event without permission, I will be subject to disciplinary actions by the program.
20. I understand that when we travel, I am responsible for reporting to the designated location at the set time. If the trip is overnight, I will report to my assigned room at curfew time, and will remain after room check until the next morning and permission is given to leave my dormitory or hotel room.
21. I understand that if I provoke other students with talk that knowingly will cause a serious disturbance or hurt feelings, in person or on social media. I will be subject to disciplinary actions up to and including termination from the TRiO Upward Bound program.
22. I understand that if I repeatedly violate the rules, I may be suspended for cumulative offenses. If being in violation on more than two occasions and different methods of discipline and counseling have had no effect, I will be subject to disciplinary actions up to and including termination from the TRiO Upward Bound program.
23. I understand that if I openly defy a staff member or fail to respond to a directive given by a member of the program staff, I will be subject to disciplinary actions of suspension up to and including termination from the program.
24. I understand that in the case that I am suspended, expelled or terminated from my high school for any reason, I will be subject to disciplinary actions up to and including termination by the TRiO Upward Bound Director.
25. I understand that re-admission into the TRiO Upward Bound program will require recommendations from high school faculty, administrators and program staff. The final decision will rest with the TRiO Upward Bound Director.
26. I understand that TRiO Upward Bound requirements may be modified to improve services, streamline reporting methods, satisfy federal guidelines and refine program goals and objectives during the year without prior notification to me.
27. I understand that during the use of the computers and Internet, prohibited CYBER BULLYING of any form will be automatic termination! I am not permitted to go on adult websites or any other websites that do not relate to the educational purposes of the TRiO Upward Bound program. If I misuse the technology, visit explicit sites or engage in inappropriate behavior using technology devices including social media/cell phones during an IRSC TRIO event, I will be subject to disciplinary actions up to and including termination by the TRiO Upward Bound Director.

 I have read and understand the Applicant Agreement and agree to abide by the rules and regulations.