Coastal Bend College-UB-2024 Application Logo
  • STUDENT APPLICATION

  • Upward Bound does not discriminate on the basis of race, creed, color, national origin, sex, age or disability. The personal information you give on the application is protected by the Federal Privacy Act. The U.S. Department of Education has the authority to gather information on all Upward Bound participants to determine eligibility and monitor their progress. No one may see any information unless they are specifically authorized. Upward Bound is a 100% federally funded program.

    • Student Information 
    •  - -
    • Needs Analysis

    • Clear
    •  - -
    • Clear
    •  - -
    • Parent/Guardian Information (To be completed by Parent/Guardian) 
    • Financial Information 
    •  
    • I the undersigned, certify there is no intent to commit fraud. I certify that to the best of my knowledge, the above information is complete, and true. I am also aware that the information provided will be used to determine eligibility and that it is subject to external verification and may bereleased for such purposes.

    • Clear
    •  - -
    • Clear
    •  - -
    • Writing Sample 
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • Browse Files
      Drag and drop files here
      Choose a file
      Cancelof
    • FERPA Form 
    • I, _{name}_ herby authorize release of my educational and employment records to the Coastal Bend College Upward Bound program.  The type of information that is to be released under this consent form includes: 

      • Transcripts
      • School Enrollment Status
      • School Credits Completed
      • Degrees Earned
      • Employment Status
      • Employment History
      • Disciplinary Records
      • Recommendations for employment or admissions to schools
      • Other Information Related to Education and Work Performance 

      The above information is to be released for purposes of verifying placement and retention in college and/or employment and for Career and Education Services staff to provide support with retention in college and employment. This information will only be shared with program staff and program funders. I understand the information may be released orally or in the form of copies of written records, as preferred by the requester. I understand that I have a right to inspect any written records released pursuant to this Consent. I understand I may revoke this Consent upon providing written notice to CBC Upward Bound. I further understand that until this revocation is made, this consent shall remain in effect and my educational and employment records will continue to be provided to the Upward Bound program for the specific purpose described above. 

    • Clear
    • Clear
    •  - -
  • Should be Empty: