University Of Texas-Arlington-UB 1-Parent Application Form

Upward Bound Parent Application

University of Texas at Arlington
Welcome Parent(s) to the Parent Application for the UTA Upward Bound- TRIO Program! To read more about UTA Upward Bound, please visit our website HERE.

This application will take you approximately 15-30 minutes to complete. If you are not able to complete in one sitting, you may save your progress and log back in with your email. Simply click the “Save” button at the bottom of the page.

The Parent Application will ask for submission of documents, including:
- Income Tax Return, Tax Transcript, or 1040s showing your family’s most recent income.
If you are having trouble with the application or need help, feel free to email us at upwardbound@uta.edu.
Student Name*

First NameLast Name
Student's Email
example@example.com
Which of the following high schools does your student attend?*

Sam Houston HSGrand Prairie HSOther
Student date of birth*

MonthDayYear
mm-dd-yyyy
Parent/Guardian #1 Full Name*

First NameLast Name
Relation
Parent/Guardian #1 Phone Number*
(999)999-9999
Parent/Guardian #1 Email Address*
example@example.com
Your preferred language*

EnglishSpanishOther
Do you have the same mailing address as student?*

YesNo
If you selected "No" please enter mailing address for parent/guardian #1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What level of education has Parent/Guardian #1 Received?*

Some High SchoolHigh School GraduateSome College2 year College Graduate4 year College GraduateCompleted Graduate School (Masters)Doctoral Degree (PhD)Other
Enter the name of the college/university *
Is there a second parent/guardian who is an active part of the student’s life and would like to be listed as a parent/guardian contact?*

YesNo
Parent/Guardian #2 Full Name*

First NameLast Name
Relation
Parent/Guardian #2 Phone Number*
(999)999-9999
Parent/Guardian #2 Email Address*
example@example.com
Parent/Guardian #2 preferred language*

EnglishSpanishOther
Does Parent/Guardian #2 have the same mailing address as student?*

YesNo
If you selected "No" please enter mailing address for parent/guardian #2*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What level of education has Parent/Guardian #2 Received?*

Some High SchoolHigh School GraduateSome College2 year College Graduate4 year College GraduateSome Graduate School (Masters)Completed Graduate School (Masters)Doctoral Degree (PhD)Other
Enter the name of the college/university *

Please list all family members living in the home (ex: Brother, two sisters, etc.)

	Name	Family Relation (ex: sister, brother...)	Age
1.
2.
3.
4.
5.
6.
7.
8.

What is your family's TAXABLE INCOME status from the last calendar year? (from Line 15 on Income Tax Return Form 1040)
PARENT/GUARDIAN SIGNATURE: Please sign (using your mouse/cursor as a pen) that you have provided us with accurate, truthful information in regards to your student's application and you understand that Upward Bound at UT Arlington may contact you and/or your child for further information?*

Clear
We are a federal funded program and need to have proof that your family financially qualifies for our services. Please upload the family most recent (last calendar year) Tax Return/ Tax Transcript/ or 1040s to demonstrate total household income. You are also welcome to email it to upwardbound@uta.edu.

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Student's Immunization Records must be uploaded here. This allows our program to ensure all of our students are hosted safely on the campus of UTA.*

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Students will be contacted by Educational Advisors about the status of their completed application. Our staff is available to provide assistance or answer any questions regarding the application process. Reach out to us at upwardbound@uta.edu or at 817.272.2610.

While we cannot accept every student, we promise to evaluate each applicant who is eligible for the services we provide and will contact applicants about their status.

The University of Texas at Arlington – Legal and Privacy Notice

Upward Bound Parent Application