Morehouse College-Phoenix Academy-UB-Application Form

Morehouse College Phoenix/Mays Program
Dear Parent/Guardian:

Your child has expressed an interest in participating in the Phoenix/Mays Upward Bound Program of Morehouse College. Phoenix/Mays is funded by the U.S. Department of Education. The Upward Bound program provides free college experience, career, and financial aid information to high school students each year. Phoenix/Mays identifies students who demonstrate an interest or desire to attend college and provides them with the motivation and support to enroll in a program of postsecondary education (college, university, and technical) after high school graduation.

Please complete the application below. All completed applications will be reviewed, and eligible applicants contacted within 14 days regarding their status.

Phoenix/Mays encourages and prepares students for postsecondary enrollment by providing students in grades 9-12 with the following services and activities through group workshops

Academic Advisement

College Awareness Activities

Career Exploration Activities

Financial Aid Awareness Activities

Scholarship Information

College & Career Field Trips

Individual Assistance with College Admissions, Scholarship Applications & Financial Aid Forms

Tutoring

In order to be eligible for selection as Phoenix/Mays participants, students must meet the following criterion:

« Be a U.S Citizen or Permanent Resident

« Be at least 14 years of age and in grades 9-12;

« Commit to remain in the Upward Bound until HS graduation;

« Demonstrate an interest or desire to attend college.

Thank you for your interest in the Phoenix/Mays Upward Bound Program. Please call us at 470-639-0229 or 470-639-0774 if you have any questions or need additional assistance.

Sincerely,

Phoenix/Mays, Program Manager

Sharon Usher

Please note that all applications are accepted for review regardless of race, color, national origin, religion, gender or disability (U.S. Dept. of Education -GEPA Section 427

PART II – Phoenix/Mays PARENT APPLICATION (To Be Completed by Parent/Guardian):
Student’s Name:

First NameLast Name
Parent/Guardian Name:

First NameLast Name
Parent/Guardian Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Home Phone Number:
(999)999-9999
Parent/Guardian Cell Phone Number:
(999)999-9999
Parent/Guardian email address
example@example.com

Educational & Household Income Information (Please note the following information is mandatory):
Educational & Household Income Information (Please note the following information is mandatory):
Does either Parent/Guardian in the household have a 4-year degree?

NoYes
Does the mother of the applicant have a 4-year degree?

NoYes
Does the father of the applicant have a 4-year degree?

NoYes
Number of people living in your house?
What is your household’s Annual Taxable Income* for the previous year?
Income Verification
Size of Family Taxable Income

1. $23,475

2. $31,725

3. $39,975

4. $48,225

5. $56,475

6. $64,725

7. $72,975

8. $81,225

Link to Federal income changes:
https://www.ed.gov/about/ed-offices/ope/trio/federal-trio-programs-current-year-low-income-levels
Did your parent(s) or guardian(s) file a tax return last year?*

YesNo
What was the taxable income of parent (s) or guardian (s) last year?
Number of Members in Household*
Select the income bracket your family falls in:*
I certify that all financial information provided in this application is accurate. I understand that falsifying information will result in the immediate rejection of this application.
Parent Signature*

Clear
Please note that Taxable Income is usually lower than Adjustable Gross Income which is located at the bottom of the first page of most tax forms. Annual Taxable Income can be found on page 2 of most tax forms. Please call 470-639-0229 if you have any questions or need assistance locating this information

I certify that the all the information provided above is correct and true to the best of my knowledge.
Parent’s Signature

Clear
Date

MonthDayYear
Date

RELEASE OF SCHOOL RECORDS
I authorize the Phoenix/Mays Upward Bound Program of Morehouse College to access and/or receive copies of my student’s academic transcripts, grade reports, report cards, test scores, and any other academic information and test results necessary to complete the program’s application process.
Parent’s Name:

First NameLast Name
Date:

MonthDayYear
Date
Student’s Name:

First NameLast Name
School:
MEDIA RELEASE

Periodically, students participating in the Upward Bound Program events may be photographed, filmed, or interviewed. As the parent and/or legal guardian of _______________________________, I grant permission for my child to participate in photographs, films, social media or interviews as they pertain to the Upward Bound Program and I understand that such pictures, films, social media, or interviews may be used to promote or publicize the Phoenix/Mays Program events or demonstrate how federal funds are being used to assist students.
Parent’s Signature:

Clear
Student’s Signature:

Clear

Morehouse College Phoenix/Mays Program

Income Verification