Gulf Coast State College-UB-2023 Application Form

  • Gulf Coast State College’s Upward Bound Participant Application (2022-2027)

    • Student’s Contact Information 
    • Date of Birth:*
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    • Are you currently served by another TRiO program?
    • Ok to text this Cell Phone?
    • Best Method of Contact:
    • Student’s Demographic Information 
    • Gender:*
    • Marital Status:

    • Independency:

    • Are you in a legal guardianship with someone other than your parent or stepparent, as determined by a court in your state of residency?
    • Are you unaccompanied and either (1) homeless or (2) self-supporting and at-risk of being homeless?
    • Do you have unusual circumstances that prevent you from contacting your parents or would contacting your parents pose a risk to your well-being?
    • Are you an orphan or ward of the court?
    • Do you have legal dependents other than a spouse?
    • Ethnicity: Hispanic/Latino?*
    • Ethnicity:*
    • Are you a U.S. citizen?*
    • Military Connections?
    • Which parent(s) did you regularly reside with & receive support from prior to age 18?*
    • Do(es) your parent(s) have a baccalaureate (4-year college) degree?*
    • Do any of the following academic situations apply to you
    • Household Information 
    • What is your family’s Taxable (not total) Income from the last calendar year? (Please mark one response only)*

    • Note: Taxable income (i.e., “Adjusted Gross Income”) can be found on a federal income tax return (e.g., Line 11a of IRS Form 1040).

    • Student’s Education/Work Information 
    • Rows
    • English Language Learner?
    • Have you ever received free or reduced lunch?
    • What is your current work status?
    • Parent/Guardian Information 

    • Mother / Guardian #1:

    • Father / Guardian #2:

    • Acknowledgments (please initial each statement) 
    • Clear
    • Date:*
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    • Clear
    • Date*
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    • Note – All services are provided free-of-charge & 100% of UB’s costs are financed with Federal funding. Please visit https://gulfcoast.edu/trio for additional disclosures UB is required to provide prospective participants and parents.

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