San Juan College-UB-Application Form

Upward Bound Program Application 2024-2025

Letter to Upward Bound Applicants:
To prospective applicants and parent/guardian(s):

Thank you for your interest in Upward Bound! Your interest in Upward Bound means that you would like to attend college after you graduate from high school and you are willing to do what it takes to be prepared for success. Graduation from high school and college are significant accomplishments for you, your family, and your community. Upward Bound can help you with your academic work, assist you in gaining college admissions, and prepare you for a successful future.

As you start the application paperwork, please carefully review the required information. If you need assistance or have any questions, please feel free to call us at the Upward Bound office at (505) 566-4237, email us at trioub@sanjuancollege.edu, or stop by the Upward Bound classroom in room 625.

PROGRAM OVERVIEW

The San Juan College TRIO Upward Bound program is a federally funded educational program that is designed to assist high school students who have the ability and desire to attend college. Upward Bound gives high school students opportunities to learn first-hand what college life is all about and helps students develop those skills necessary to be successful in college. The program emphasizes reading, writing, math, science, foreign language, study skills support, and leadership development. The program also provides opportunities for personal, social, and cultural enrichment.

ELIGIBILITY REQUIREMENTS

To qualify for the program, you must meet the following criteria:
- Must be enrolled in the 9th, 10th ,11th, 12th grade at Bloomfield High School
- Must be a first-generation college student (neither biological parent has graduated from college with a bachelor’s degree)
  AND/OR must meet the U.S. Department of Education Income Guidelines
- Must show an academic need for Upward Bound services
- Be a U.S. Citizen or Permanent Resident
- Indicate a strong desire to succeed in school and enroll in college right after high school graduation
- Commit to remain active in UB through high school graduation
UB SERVICES
- Year-round intensive academic instruction in mathematics, reading, language arts, literature, science, foreign languages,
  study skills, and more
- One-on-one academic advising
- Personalized tutoring from professional tutors
- Personalized assistance in completing college entrance exams, tips for test taking, college admissions applications, and
  financial aid and scholarship applications
- Instruction in college planning and life skills training, including financial literacy education and leadership development
- College visits
- Financial education
- Career education and exploration
- Cultural enrichment activities
- Opportunities to travel
- Opportunities to make friends with other high school students who also want to go to college
- Stipends for UB participation and good grades
STATEMENT OF CONFIDENTIALITY

The personal information you give to Upward Bound is required by the United States Department of Education. The information is protected by the Federal Education Right to Privacy Act (FERPA). No one may see the information unless they are employed by the Upward Bound program and are specifically authorized to determine your eligibility to participate in the program. The information required by the U.S. Department of Education is used for evaluation purposes and to verify student eligibility.

In order to comply with federal regulations, we gather income, citizenship, and other qualifying information. All of the information you provide is protected by the Privacy Act. Only TRIO Upward Bound staff have access to the information provided.

APPLICATION CHECKLIST

Please read and follow the instructions given on each page. Be sure that all forms have the required signatures and that you have completed each section accurately and thoroughly.

Part 1 - Student Information
- Completed student information form
- Student self-assessment
Part 2 - Family Information
- Completed family information
Part 3 - Program Eligibiliy Verification
- Completed income and parent education verification
Part 4 - High School Information Release
- Signed high school information release
Part 5 - Teacher Recommendation Forms (Optional)
- Two completed core subject teacher recomendation forms
Need help filling out your application? Please contact us!

Phone: (505) 566-4237
Email: trioub@sanjuancollege.edu
Bloomfield High School, Room 625

Student Self-Assessment
The student self-assessment section is an important part of the selection process and must be completed by the student. Your responses help us better understand your personal and educational goals and your need for Upward Bound services.
Are you interested in going to college?*

YesNo
Do you feel you could benefit from extra academic assistance?*

YesNo
Please rate your need for extra help and support with the following academic skills:

English and Writing Skills*

	High Need	Some Need	No Need
Spelling and grammar
Writing essays
Speaking skills
Reading skills
Learning/Improving English as a second language

Math Skills*

	High Need	Some Need	No Need
Basic arithmetic (addition, subtraction, multiplication, division)
Algebra
Geometry
Advanced math

Learning and Study Skills*

	High Need	Some Need	No Need
Time management
Developing good study habits
Note taking strategies
Staying organized

Careers*

	High Need	Some Need	No Need
Exploring career options
Identifying career interests

College*

	High Need	Some Need	No Need
Exploring and researching different colleges
Applying to colleges
Applying for financial aid and scholarships
Visiting local college campuses

Personal Motivation*

	High Need	Some Need	No Need
Improving school attendance
Completing schoolwork and homework
Building self-confidence
Improving social skills

Part 2: Family Information
Parent/Guardian #1
Parent/Guardian Name:*

First NameLast Name
Relation to Student:*
Email:*
example@example.com
Best Phone Number to be Reached:*
(999)999-9999
Phone type:*

CellphoneLandline
Place of Employment:
Work Phone:
(999)999-9999
Parent/Guardian #2 (If applicable)
Parent/Guardian Name:

First NameLast Name
Relation to Student:
Email:
example@example.com
Best Phone Number to be Reached:
(999)999-9999
Phone type:

CellphoneLandline
Place of Employment:
Work Phone:
(999)999-9999

Part 3: Program Eligibility Verification
The U.S. Department of Education requires that the following information be provided for all participants prior to program entrance. All documentation will be held strictly confidential by San Juan College TRIO Upward Bound program staff.

The information below is used to determine whether or not your child is eligible to receive Upward Bound services. Upward Bound is a federally-funded program. Because of this, students must meet specific family income and/or parent educational status requirements to receive services.
Number of family members living at home, including yourself:*
Total Annual Taxable Income: (includes income from work, Social Security, benefits, aid for dependent children, State Disability, worker's compensation, child support, Unemployment Benefits, Veterans Benefits, Retirement/ Pension, etc.)*
Total taxable income can be found on line 15 of the 1040EZ tax form.
Biological Parents' Educational Status:
Does the student's biological mother have a bachelor's degree?*

YesNo
Does the student's biological father have a bachelor's degree?*

YesNo
Is the student the first in the immediate family to attend college?*

YesNo
Please verify that total annual taxable income and biological parents' educational status are correct to the best of your knowledge before signing.

Certification: All of the information provided on this form is true and complete to the best of my knowledge.
Signature of parent or guardian

Clear
Date

MonthDayYear
mm-dd-yyyy

Part 4: High School Information Release
As part of the application process, Upward Bound staff assess potential applicants’ academic history using information provided through PowerSchool by the Bloomfield School District. If your child is accepted into the program, UB staff will regularly access your child’s information in PowerSchool in order to assess their academic progress.
HIGH SCHOOL INFORMATION RELEASE AUTHORIZATION

I hereby authorize school officials in my school district to release any requested academic or personal information (transcripts, report cards, progress reports, monthly detailed grade reports from PowerSchool, class schedules, attendance data, test scores, disciplinary records, IEP reports, 504 reports, change of address, etc.) to the San Juan College TRIO Upward Bound program. Upon enrollment in Upward Bound, I understand this information will be provided until all high school graduation requirements are met.
Date*

MonthDayYear
mm-dd-yyyy
Print Name of Student*

First NameLast Name
Signature of Student*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Print Name of Parent*

First NameLast Name
Signature of Parent*

Clear

Part 5: Teacher Recommendation Forms (Optional)
Teacher recommendation forms are an optional part of the Upward Bound application. However, because Upward Bound is a selective program that is only able to serve 60 students, students who submit teacher recommendation forms may receive a higher score on our applicant scoring system. It is to your advantage to submit two teacher recommendation forms.

Please note, only recommendation forms completed by a core subject teacher (math, science, English, history) will be accepted.

After you have completed this application, Upward Bound staff will deliver paper copies of the teacher recommendation form to you. It is the student's responsibility to choose two core teachers to complete the forms and ensure that the forms are returned to Upward Bound. Directions for how teacher recommendation forms can be returned to Upward Bound are printed on the recommendation forms.

Upward Bound Program Application 2024-2025

Parent/Guardian #1

Parent/Guardian #2 (If applicable)