CU TRIO Upward Bound Student Information Form

The levels listed above are based on the size of my family unit. I understand that my family unit includes myself, my spouse (if applicable), and my dependents. If I (a student) am a ward of the court, my family unit includes only myself.

I also understand that this is a federally funded program and that this information is subject to review by Federal authorities if the TRIO program to which I have applied is audited, and I will be held responsible for the certification made by my signature. I affirm that this information is true and accurate to the best of my knowledge.

I authorize the staff of the Coker University Upward Bound Program to access academic and personal information in my student’s legitimate educational interests. This information may include but is not limited to: standardized test scores (PSAT, SCPASS, AP, SAT, ACT, GED); report cards; unofficial transcripts; official transcripts; attendance and disciplinary records; information about the status of post secondary education admission/enrollment; financial aid documentation including South Carolina Common Application information, FAFSA pin information code, and financial aid award letters by The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post-secondary education. I further understand all information received is for Upward Bound use only and is held strictly confidential.

I understand that these records may contain identifying data, grade reports, high school and future college transcripts, test scores, immunization records, and teacher evaluations. The parent or student may examine a copy upon request.

I understand that these records will only be used by the project on an individual basis. I also understand that compiled records on a group basis may include any of these records. Compiled information will be used to meet federal regulations of program evaluation.

Furthermore, I permit for Upward Bound to access and collect this information for a period or until I/my student successfully program of post-secondary education. However, if I choose to withdraw this permission, I can call the Program Director.

Authorization for Student Participation

 

THIS FORM COVERS ALL FIELD TRIPS FROM

September 1, 2022 - August 1, 2023

****Parents/Guardians, please complete all of the following information:****

A. Parent/Guardian Permission
I understand that my son/daughter is not required to attend this field trip. I permit my child to participate in the activity. I agree to release Coker University Upward Bound and its officials, officers, and employees from liability for any injury that might occur while my son/daughter is participating in this field trip activity.

B. Emergency Medical Authorization

Should a medical emergency arise while my son/daughter is participating in this activity, I will be notified at the above number to approve medical treatment. In the event of the emergency contacts listed below cannot be reached, I give permission for immediate treatment as required in the judgment of the attending physician. I understand and agree that I will be responsible for the cost of such treatment. 

for Coker University Upward Bound Program

I hereby give permission for my child, {main_name} to be videotaped and/or photographed during educational activities with the Upward Bound program of Coker University for the duration of the student's participation in Upward Bound.

I understand that my child will be identified by his/her first name only. The name of the class, school, and city in which my child is located may be identified during the videotaping and/or photography or in any corresponding reproductions in publications and the Internet.

I further understand that these videotapes and/or photographs are property of the Coker University Upward Bound Program. The videotapes and/or photographs will be used only to explain Trio programs and services, and/or to illustrate teacher instruction activities during professional development events. Publication purposes include permission and consent to reuse,disseminate, copyright, print, reproduce, publish and republish, for any commercial, advertising, and publicity purposes.

I hereby release and discharge the Coker University staff from any claims and demands arising out of or in connection with the use of any of the foregoing, including defamation, invasion of privacy, or violation of any statutory right.

Acceptance into the Upward Bound Program brings with it several responsibilities for both students and parents. PLEASE REVIEW CAREFULLY THE FOLLOWING CONDITIONS FOR PROGRAM PARTICIPATION: The student pledges:

1. To participate in the Summer session each year, including attending classes and special activities. 
2. To participate in the academic program during the school year by attending tutoring sessions, attending Academic Saturdays, meeting with UB mentor, and completing assignments.
3. To show continued individual effort regarding school attendance, citizenship, and scholarship.
4. To participate in special activities, trips, meetings, and events sponsored by Upward Bound.
5. To fulfill commitments made regarding the attendance of activities, trips, meetings, and events sponsored by Upward Bound. Failure to do so will result in administrative action.

Discipline:

To maintain a positive atmosphere whereby each student can achieve maximum academic and social development while enrolled in Upward Bound, all participants must conduct themselves in an orderly and respectful manner at all times. Therefore, they must pledge themselves to the following: 

1. To respect all teachers, tutors, tutor advisors, and members of the Upward Bound staff. (Failure to do so may result in probation.)
2. To follow all rules and regulations as outlined in Upward Bound school year and summer handouts.
3. To come to class and tutoring sessions prepared to engage in serious academic study.

Parent Responsibilities:

1. To attend scheduled parent meetings and student conferences as necessary. 
2. To cooperate with the Upward Bound administration in resolving problems and conflicts regarding his/her child while in the program.
3. To provide transportation for your student as needed in support of your child’s participation in the Upward Bound program.

Probationary Period:

The probationary period for an Upward Bound student is 60 days. During this period, if a student fails to actively participate in every aspect of the program, he/she will be dropped from the program at the close of the probationary period. 

The student and parent hereby acknowledge having read and comprehended the “Upward Bound Parent/Student Contract” and agree with and pledge to abide by its provisions.