Avila University-Project Achieve-UB-Application Form

Upward Bound Application Form
Upward Bound Program

Avila University

11901 Wornall Rd., Kansas City, MO 64145

Office: (816) 501-0441 - Fax: (816) 501-2462

Email: Shannon.Keys@avila.edu - Website: www.avila.edu
What is TRIO Upward Bound?

The Federal TRiO Programs (TRiO) are federal outreach and student services programs in the United States designed to identify and provide services for individuals from disadvantaged backgrounds. They are administered, funded, and implemented by the United States Department of Education.

Upward Bound, in particular, provides fundamental support to high school participants in their preparation for college entrance. The program provides opportunities for participants to succeed in their precollege performance and ultimately in their higher education pursuits. Upward Bound serves high school students from low-income families and high school students from families in which neither parent holds a bachelor's degree. The goal of Upward Bound is to increase the rate at which participants complete secondary education and enroll in and graduate from institutions of postsecondary education.

FREE services offered by Upward Bound
- Tutoring
- Extra Academic Enrichment
- ACT Prep
- Advising
- College Readiness Advising
- College Visits
- Career Exploration
- Cultural/Social Exposure
- Summer Programming
Application Process
1. Fill out the attached application in its entirety (an incomplete application will not be accepted) and submit.
2. After your application is reviewed, you will be contacted by email or phone about your eligibility status and to possibly set up an interview.
3. Both student and parent/guardian(s) participate in an interview process.
4. Notification of acceptance

Section 3. Financial Eligibility Determination
To be completed by the Parent/Guardian.
The Upward Bound Program at Avila University and the United States Department of Education require all applicants to submit a signed statement of tax information from their parent/guardian’s most recent filed tax returns. Please, fill out the following information as it relates to your particular situation.
Tax Year*
Please choose one of the following prompts that fit your situation*

I DID NOT file taxes for this tax year because I did not meet federal income requirements to file.I DID NOT file taxes for this tax year because I receive disability and/or social security or another form of federal assistance.I DID NOT file taxes for this tax year for (explain reason in field below)I DID file taxes for this tax year (fill in below fields)
I did not file taxes for this tax year because:*
My family's taxable (not gross) income was:*
Your taxable income can typically be found at the end of the first page of your 1040 tax form on line 15.
My family size was:*
I,*

First NameLast Name
certify, under penalty of perjury, that the financial information provided above in this application is accurate and true.
Parent/Guardian's Printed Full Name*

First NameLast Name
Parent/Guardian's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
The Upward Bound Program at Avila University will secure and maintain your information in strictest confidence. Please contact Upward Bound if you have any questions or concerns regarding your personal financial information.

Section 4. Authorization for Release of Records
To be completed by the Student & Parent/Guardian.

I hereby authorize the of release transcripts, grades, progress reports, standardized test scores (included but not limited to EOC, MAP, ACT, SAT, PLAN, PSAT scores, & National Student Clearinghouse), attendance records, conduct and behavior reports, and other educational information to the Upward Bound Program at Avila University. In addition, the Upward Bound staff may meet with my student at school as necessary to discuss academic and personal issues. I also give Upward Bound permission to use the participant’s photo for advertising and social media purposes in regards to the program.

By signing this, I understand that all information gathered will be kept strictly confidential and will not be communicated to any other person(s) or organization(s). I authorize the Upward Bound Program at Avila University to request and obtain these documents for as long as necessary for federal reporting purposes.
Student's Printed Name*

First NameLast Name
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian's Printed Name*

First NameLast Name
Parent/Guardian's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. The Upward Bound Program at Avila University will not permit access to or the release of personally identifiable information contained in student educational records to any party without the written consent of the student, except as authorized by FERPA.

Section 6. Signatures
To be completed by the Student & Parent/Guardian.

I certify that the information submitted in this application is true and correct to my knowledge. I further understand that any false statements may result in the loss of eligibility for the applicant’s acceptance into the program.
Student's Printed Name*

First NameLast Name
Student's Signature*

Clear
Parent/Guardian's Printed Name*

First NameLast Name
Parent/Guardian's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

Upward Bound Application Form