Laredo Community College-UB-Application Form

TRiO Upward Bound

Laredo College
Students Information
Name*

First NameMiddle InitialLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone #:
(999)999-9999
Cell Phone #:
(999)999-9999
Personal email:*
example@example.com
Are you a US Citizen or Permanent Resident:

YesNo
Date of birth:

MonthDayYear
Date
Gender
High School Attending:
High School Attending:*
Current Grade:
Current Grade:
Who do you live with? (Select all that apply)

MotherFatherGuardian
Parent or Guardian Information
Father’s/Guardian’s Information
Name

First NameMiddle InitialLast Name
Phone #:
(999)999-9999
Personal email:
example@example.com
Father’s highest grade completed

Some College2 Year Degree4 Year DegreeOther
Mother’s Information
Name

First NameMiddle InitialLast Name
Phone #:
(999)999-9999
Personal email:
example@example.com
Mother's highest grade completed

Some College2 Year Degree4 Year DegreeOther
Parents preferred language

SpanishEnglishBoth
Please note this part is to be filled out my parent/guardian. Indicate house hold size (include yourself, your spouse(if married), your children and other dependents (who are not your children or spouse) who will receive more than half of your support.
Academics
What subject(s) are your favorite and which are your least favorite?
What math have you recently or currently taking? What grade do you have?
Have you been absent from school in the past? Why and how often?
Do you plan to go to College?

YesNo
If so, what do you plan to study?
Have you ever been sent to the office for disciplinary problems? If so, what was the reason?
Are you a part of another federally granted program such as Gear-Up?

YesNo
If so, Which one:
Required Documents
Schedule an appointment to submit application and required documentation by calling our office at (956)721-5238.

To the appointment bring the following documentation:
- Students Proof of citizenship or Residency: Birth Certificate or Permanent Resident Card
- Parents Most Recent Income Tax Return (1040)
- Recent Utility Bill
- Students Most Recent Report Card (Must include attendance record)
- Students Vaccination Record (Student must have the meningitis vaccine)
- Students STAAR Scores
- Counselor Recommendation (Letter Provided by UB Office)
Individual Needs Assessment

Select the best answer that describes you.

Rows	Strongly Need Help	Need Some Help	Don’t Need Help
1. Understand my abilities and interest
2. Improve my self-confidence
3. Set goals in life
4. Be more accepting of others who are different from me
5. Improve my listening skill
6. Have someone to listen to my problems
7. Improve my relationship with my family
8. Understand how my career choices affect what’s important to me
9. Understand ACT/SAT/THEA scores
10. Receive help with math and/or science
11. Receive help in English and/or Reading
12. Improve my study skills
13. Improve my decision-making skills
14. Be more knowledgeable about high school curriculum
15. Participate more in cultural events

Getting to know you
Submit a typed statement telling us more about yourself. Include an interesting fact about yourself, hobbies, extracurricular activities you are involved with or would like to be involved. We would like to hear about your short and long-term goals and what career goals you have. In this essay also explain how you heard about Upward Bound (UB) and why you would like to join our program as well as why we should welcome you to UB. Essay must be at least 250-300 minimum.

TRiO Upward Bound

Students Information

Parent or Guardian Information

Academics

Required Documents

Individual Needs Assessment

Getting to know you