Alabama A & M University-Normal-UB-Application Form

Alabama A & M University TRiO-Upward Bound Program Application
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Application Packet Checklist

Student Application: Student & Family InformationStudent Essay: Written 150 words or more explaining your interests in the program, educational goals, and career choices & objectivesTwo (2) Teacher Evaluation FormsOne (1) School Official Recommendation Form (MUST BE THE: Principal, Assistant Principal, or Counselor)One (1) Written or Typed Recommendation Letter from the Community (i.e. church official/member, neighbor, family friend)Official School Transcript & Cumulative RecordIncome Verification Form
For More Information contact -

Aleshia Grant, LMSW (256)372-5252
Program Coordinator
aleshia.grant@aamu.edu

Sylvette Monroe (256)372-4702
Office Manager
sylvette.monroe@aamu.edu

Angela Strickland (256) 372-4709
Administrative Support
angela.strickland@aamu.edu

Dr. Jamie Flanagan
Director of TRIO Upward Bound
jamie.flanagan@aamu.edu
256-372-4286
STUDENT INFORMATION
Applicant Name:*

First NameMiddle NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Contact Number
(999)999-9999
Parent/Guardian Email Address
example@example.com
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Cell Phone:
(999)999-9999
Gender:

MaleFemale
Student Email:*
example@example.com
Social Security Number:
999-99-9999
U.S. Citizen:

YesNo
Birthdate

MonthDayYear
mm-dd-yyyy
Ethnic Status: (please check)

Black/African AmericanHispanic/LatinoAmerican Indian/Alaskan NativeWhiteAsianOther
Current School:
Current Grade:
If you are currently in the 8th grade, Please select the high school you will be attending next semester

Columbia HighJemison HighLee HighBuckhorn HighHazel Green HighSparkman High/Sparkman 9Grissom HighOther
Are you participating in any other TRIO Program?

YesNo
(If ‘Yes’, check all that apply)

Upward BoundTalent SearchUpward Bound Math-ScienceGEAR UP
FAMILY INFORMATION
With whom does the student live?

Both ParentsMotherFatherGrandparentFoster CareOther
Parent(s) Marital Status:

Married, living togetherMarried, living separatelySingleDivorced
If Deceased:

MotherFather
Select highest level of education completed.
Mother/Guardian

High school graduateTwo years of collegeFour-year college degreeMaster’s degree & above
Father/Guardian

High school graduateTwo years of collegeFour-year college degreeMaster’s degree & above
Total number of members in the household:

List each name of the members of the household & their relationship to the student:

	Name	Relationship
1
2
3
4
5
6
7
8

The information contained in this application is for the use of the Alabama A&M University TRiO-Upward Bound Program and will be held in the strictest of confidence. Please certify that the information is correct and complete by signing below.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature:

Clear
Date:

MonthDayYear
mm-dd-yyyy
Student Essay
Please provide a handwritten essay with 150 words or more explaining your interest in the program, educational goals, career choice(s), and how could you benefit from the program.
The information contained in this application is for the use of the Alabama A&M University TRiO-Upward Bound Program and will be held in the strictest confidence. Please certify that the information is correct and complete to the best of your knowledge by signing Below.
Student Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
INCOME VERIFICATION
All applicants must complete this section, whether or not you believe you qualify as low-income.

As a federally funded TRiO program, Upward Bound is required to provide documentation of a student’s eligibility for the program to the U.S. Department of Education and implement the TRiO regulations that state two-thirds of the students served must meet federal low-income guidelines.

Parent/Guardian income information and signature are required if the student can still be claimed as a dependent according to Federal Financial Aid law. TRiO Upward Bound assures that all family and student information is kept confidential.
Please check one:

Yes, I amNO, I am NOT - A Potential First-Generation College Student
(means I am an individual neither of whose natural parents, legal guardians, adoptive parents received a baccalaureate 4 yr. degree)

Option 1: Filed a Tax Return
the previous tax year of 20 __ __
What was your (the student’s parent/guardian’s) taxable income for the previous tax year
(Form 1040, line 15; Form 1040SR, line 15)
How many members of the household were included on this tax return?
(Forms 1040 or 1040SR)
What was your filing status on this tax return?

SingleMarried Filing JointlyMarried Filing SeparatelyHead of Household
Signature of Parent or Legal Guardian (if dependent) or Self (if independent)

Clear
Option 2: Did Not File a Tax Return

In accordance with the eligibility requirements set forth by the U.S. Department of Education, I hereby certify that NO Federal or State tax return documenting my income was filed with the Internal Revenue Service for the previous tax year.
Total income- year of 20 ___ ____
I certify that TOTAL INCOME from all sources in the year was $___________________.
How many members are part of your household (include yourself)
Signature of Parent or Legal Guardian (if dependent) or Self (if independent)

Clear

Alabama A & M University TRiO-Upward Bound Program Application

STUDENT INFORMATION

FAMILY INFORMATION

Student Essay

INCOME VERIFICATION