College Bound Institute-South Dade-UB-Application Form

CBI South Dade - Upward Bound Program
Thank you for your interest in our CBI TRIO Upward Bound program.This program is for high school students only.

Please complete this application as thoroughly as possible. You cannot save and continue this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, please call our office at (305) 697-3810.

*Important! While you may fill this form out on your phone, it is best to complete this form on a computer*

Parent/Guardian and Student Consent
Permission for Release of Records: Do you, the Parent/Guardian, give permission for the release of student records, including grades, test scores, and attendance information, to authorized personnel for the purposes of evaluation and program eligibility? (Please note that without your consent, the student will not be eligible to participate in the program, as the review of academic records is required for grant compliance.)*

Yes, I consentNo, I do not consent
Student Participation Consent: "I, the student applicant, hereby understand that if selected to be a participant of the Upward Bound South Dade Program, my participation in events, activities, workshops, trips, etc. is voluntary, and I am willingly signing up to participate in the afore mentioned program/event. Failure to show up and participate as agreed will prevent my activity and invitation to participate in future programs/event hosted by the College Bound Institute’s Upward Bound South Dade Program. Should I decide that I no longer wish to participate, I will contact program leadership immediately to be removed from the program."*

Yes, I consentNo, I do not consent
By signing below, you certify that the above information and income data is correct to the best of your knowledge. Furthermore, your signature verifies your understanding that all information you have provided is confidential.
Parent/Guardian's Signature*

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Date Signed*

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TRIO

Upward Bound

CBI South Dade - Upward Bound Program

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