• The University of Tennessee TRiO / Pre-College Upward Bound

    Student Application Form
    • Personal Information 
    • Date of Birth:
       - -
      2 digit month, 2 digit day, 4 digit year
    • Gender:
    • Ethnicity / Race:
    • Are you currently participating in another TRiO Program (Upward Bound or Talent Search)?
    • Are you a U.S. Citizen or Permanent Resident of the U.S.?
    • Do you have a disability?
    • If YES, Please describe:
    • Is English your primary spoken language?
    • Parent / Guardian Education and Employment 
    • With whom do you currently live?
    • Check all that apply to Parent / Guardian One only:
    • Active Duty or Veteran of the Armed Services?
    • Check all that apply to Parent / Guardian Two:
    • Active Duty or Veteran of the Armed Services?
    • Academic Information 
    • Current Grade Level:

    • Standardized Test Scores:

    • Math courses completed and grades earned (A, B, C, D, F) for high school credit (include Algebra 1 if taken in 8th grade):
      Rows
    • Educational plan after high school:
    • Academic Need 

    • For each statement please select the answer that best describes your situation. It is important to be honest when answering these questions.

    • 1. My grade point average (GPA) is below 2.0.
    • 2. I have low achievement test scores.
    • 3. I wish to go to college after high school.
    • 4. I have the opportunity to take challenging college preparatory classes in high school.
    • 5. Teachers and/or school counselors encourage me to take challenging college prep courses.
    • 6. My parent(s) encourage me to take challenging college prep courses.
    • 7. I need information regarding careers in order to determine my future goals.
    • 8. I have limited proficiency in the English language.
    • 9. I have the confidence, self-esteem, and social skills to be successful.
    • 10. Most of the people living in my community are from low-income families.
    • 11. I live in an extremely rural part of the state.
    • 12. I need to learn how to ask better and/or clearer questions in class.
    • 13. I need to learn better note-taking strategies.
    • 14. I need information on listening more effectively.
    • 15. I feel comfortable in new situations.
    • 16. I want to learn about the wise use of loans, credit, and money.
    • 17. I speak very well in front of a group of people.
    • 18. I need help with the ACT test.
    • 19. I want to learn how to recognize my strengths and weaknesses.
    • 20. I want to learn to set goals and make plans to reach them.
    • 21. I do not know how to interact well with teachers.
    • 22. I need to learn problem-solving techniques.
    • 23. I need to learn how to express myself more effectively.
    • Self-Report Questionnaire 

    • Read each question below carefully. Select the answer that you believe is most true for you and / or complete the statements below.

    • 2. Going to college after high school:
    • 3. I plan to complete the following educational level:
    • 4. Three careers I have considered pursuing are:
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    • 5. My favorite classes in high school are:
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    • 6. My least favorite classes in high school are:
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    • 7. Please check the academic areas in which you excel:
    • 8. Dropping out of high school is:
    • 9. Describe your attendance record for your high school career:
    • 10. Three things I am proud of are:
      Rows
    • 11. Three goals I have for myself are:
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    • 13. Which of the following would be the most likely reason that you would not achieve your educational goals? (select all that may apply)
    • 14. If you are selected to be a participant in UTK's Pre-College Upward Bound program, will you be able and willing to: 1) attend Saturday sessions; 2) participate in all online activities; 3) take required tutoring if necessary; 4) attend at least one 6-week summer program with 2-4 weeks residential; and 5) arrange your schedule around program activities?
    • Student Interest Survey 
    • What would you most like to receive from UTK's Pre-CollegeUpward Bound Program? Please check all boxes that apply to you
    • Application Materials Checklist 

    • In addition to this application, you must submit the following materials.

      • If you are not a U.S. citizen, you MUST submit one of the following:
        • Official documentation that you are a permanent resident of the United States, OR
        • Official documentation that you are in the United States for other than a temporary purpose, and evidence from the U.S. Citizenship and Immigration Services (USCIS) of your intent to become a permanent resident.
      • Copy of your parent's or guardian's complete 1040 or 1040-SR income tax form, and / or the Confidential Financial Statement completed in its entirety and signed by a parent / guardian.
      • Signed School Release Form
      • Signed Transportation Permission Slip & Liability Release Form
      • Signed School Counselor Recommendation Form
      • Signed Teacher Recommendation Form

       

      You may give your completed application materials to your high school Pre-College Upward Bound Educational Specialist, your high school counselor, or you may send them directly to the UTK Upward Bound Office at the following address:


      The University of Tennessee Upward Bound Programs
      Attn: Jonathan F. Curry
      1914 Andy Holt Avenue, 25 HPER Bldg.
      Knoxville, TN 37996
      Phone: (865) 974-4466

    • Date:
       - -
      2 digit month, 2 digit day, 4 digit year
    • Submit 
    • Should be Empty: