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*

    • Student Information: 
    • Are you a citizen of the United States?
    • Birthday*
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    • Does the Student Have Limited English Proficiency*
    • Current School:*
    • Degree Track*
    • Other Academic Needs*
    • Educational Plans*
    • Select all of the services you are interested in:*
    • Are you, the student applicant, currently employed?*
    • Do you have a reliable source of transportation?*
    • Do you, the student applicant, have a car?*
    • Student's T-Shirt Size?*
    • Were you referred to TRIO Upward Bound South Dade by someone?
    • Eligibility Confirmation 

    • The parent(s)/guardian(s) with whom the student lives with AND/OR who files taxes for the student applicant should complete this section

    • Are you, the student applicant, a citizen, national OR permanent resident of the United States of America?*
    • Is the student a Ward of the State, Emancipated, or in Foster Care?*
    • Are you, the student applicant, a Ward of State? (i.e., a person, typically a minor, who has a guardian appointed by the court to care for and take responsibility for that person in absence of their biological parents)*
    • Are you, the student applicant, currently in Foster Care?*
    • Are you, the student applicant, Homeless?*
    • Relationship to Student*
    • Does Parent/Legal Guardian 1 currently reside in the same household as the student applicant?*
    • Was the degree earned in the United States of America?*
    • Relationship to Student (i.e. father, grandfather, uncle, etc.)
    • Does Parent/Legal Guardian 2 currently reside in the same household as the student applicant?
    • Was the degree earned in the United States of America?*
    • Parent/Legal Guardian 1 will be the primary contact for all program updates and information related to the student applicant. Would you like Parent/Legal Guardian 2 to also receive program updates and information regarding the student applicant?
    • Income information 
    • Please check your TAXABLE income from the prior year (line 11 on 1040 form). This information may be helpful in notifying the student about financial aid, scholarships, and other special programs.*
    • Does the student receive free/reduced lunch: *

    • Sign and Submit:

    • Applicant Signature*

    • Please select a signature verification type.

    • 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.)*
    • 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."*

    • 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.

    • Date Signed*
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    • TRIO

      Upward Bound

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