299456-Vaughn College Of Aeronautics & Technology-UB-2024 Summer Application

Upward Bound Program at Vaughn College Summer Application

86-01 23rd Ave, East Elmhurst, NY 11369 | Oﬃce LL15

ub@vaughn.edu | 718.429.6600 ext. 143

Upward Bound is a federally funded TRIO program that helps low-income and ﬁrst generation community youth achieve college and career success by providing a year-round comprehensive system of support including tutoring, college entrance examination preparation, college admission and ﬁnancial aid application assistance, cultural ﬁeld trips, mentoring, and more.

Student Name*

First NameMiddle InitialLast Name

Preferred Name*

Social Security Number

999-99-9999

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number*

(999)999-9999

Email*

example@example.com

Date of Birth*

mm-dd-yyyy

Gender*

Citizenship Status (select one):*

U.S. CitizenPermanent ResidentOther

Race*

Race: Hispanic/Latino*

YesNo

School (select one)*

Grade Level (select one)*

9th10th11th12th

OSIS (Student ID#)*

Cumulative Average/GPA*

English Regents Score*

Algebra 1 Regents Score*

Homeless or Foster Care:*

YesNo

Limited English Proficiency*

YesNo

First Language*

Are you available from July 15 to August 16 from 9 am to 3 pm?*

YesNo

What's your T-shirt size?*

Do you want to attend college?*

YesNo

Which college do you want to attend?*

Please tell us about yourself and explain why you want to be a part of the Upward Boundprogram.*

Student Lives With (check all that apply):*

Emergency Contact Name*

First NameLast Name

Phone*

(999)999-9999

Relationship*

Parent Guardian #1 Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Check below if Address is the same as student

Address is same as student

Phone Number*

(999)999-9999

Email

example@example.com

Obtained Bachelor's Degree:*

YesNoUnknown

Parent Guardian #2 Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Check below if Address is the same as student

Address is same as student

Phone Number*

(999)999-9999

Email

example@example.com

Obtained Bachelor's Degree:*

YesNoUnknown

Annual taxable income*

Family Size*

I verify that my family’s annual taxable income is $_{annualTaxable}_ and that there are _{familySize}_ family members in my family unit. (At least 66% of Upward Bound students’ families are low-income.)

Commitment of Student’s Participation:

I parent/guardian understand the purpose of the Upward Bound (UB) program, which is to prepare students/scholars to successfully complete a program of post-secondary education, and grant the student/applicant/scholar permission to participate in the UB program and all of the activities related to the program.
Because family/parent involvement and support are major contributing factors to student success, I agree to be involved in the following ways: keeping informed of the student’s progress in school, encouraging and allowing the student to attend all UB activities and ﬁeld trips, participating in UB events in which parents are invited, sharing concerns about the student’s education with the UB staﬀ, and supporting the UB staﬀ in their eﬀorts on behalf of the student. I support the mission of UB and will make it a priority to assist in the student’s education.
I agree that the student’s education is of utmost importance and must come ﬁrst among work, athletics, and other programs. Should the student’s education begin to fail, I will meet with the UB staﬀ to ﬁnd the best solution for the student, including removing the student from any activity aﬀecting the student’s academic performance.
Authorization for Academic Records Release- I grant the UB program staﬀ permission to receive copies of education records and other materials necessary for participation in the program. Further permission is granted to request academic and ﬁnancial aid information and records from any post-secondary institution to track college progress. I consent to release the student’s grades, test scores, and any other academic records from high schools and colleges to the Upward Bound program.
Media Release- I grant the UB program and Vaughn College staﬀ permission to text phone numbers and capture the student in photograph and video to be used in promotional ads such as but not limited to ﬂyers, brochures, and presentations for Vaughn College of Aeronautics and Technology and the Upward Bound program.
Medical Release- I grant permission of the UB program staﬀ or authorized representative to furnish ﬁrst aid to the student, as well as seek medical attention in the event of a serious illness or hospitalization, as necessary in the best interest of the life of the student.
The student will comply with all the rules and regulations of the UB program, Vaughn College, and visiting facilities and is aware that failure to comply will result in dismissal from the program.
The student understands and willingly commits to these expectations. I fully understand and support the student’s attendance and participation in the following activities: Saturday Academy (9:00 am to 1:00 pm), tutoring, workshops, Summer Academy (6 weeks in July-August), overnight college tours, and scheduled ﬁeld trips and activities.

I hereby attest that all information in this application is true and correct. I also understand that a false statement or misrepresentation will make the applicant ineligible for the Upward Bound program.

Parent/Guardian Signature*

Print Parent/Guardian Name*

First NameLast Name

Date*

mm-dd-yyyy

Student Signature*

Print Student Name*

First NameLast Name

Date*

mm-dd-yyyy