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  • Achievers Upward Bound Math & Science Program Student Application

  • Dear Applicant:

    Thank you for your interest in the Jackson State University Achievers Upward Bound Math & Science Program. The Upward Bound Program is a free college preparatory programs for high school students funded by the U.S. Department of Education and sponsored locally by Jackson State University. The Achievers Upward Bound Math & Science Program is designed to provide participants the skills and motivation necessary to navigate and complete a program of secondary education and to enter and succeed in a program of post-secondary education.

    The Upward Bound Math & Science is a year-round program. The program provides tutorial services, classes, and special events during the school year to strengthen academic skills and prepare students for success at the college level. The program also provides academic advising and individual assistance with the college admissions and financial aid application process during the academic school year. Our six-week summer academic component is designed to simulate a college-going experience that includes daily coursework in math, laboratory science, composition, literature, foreign language as well as cultural, social, and recreational events and activities.

    Eligibility to participate in the program is determined individually. Each applicant must meet basic eligibility requirements set forth by the U.S. Department of Education, that require neither parent to have a four-year college degree and family income verification. The program services 30 students from Humphreys County High School and 30 students from Yazoo City High School. Therefore, it is important that you complete your application as soon as possible. When space is not available, an application will be placed on our waitlist for later consideration. Applications are considered on a first come first serve base.

    All completed applications will be reviewed and eligible applicants contacted for a student and parent interview with program staff.

    Thank you for your interest in the JSU Achievers Upward Bound Math & Science Program. Please call a staff member at (601) 979-0313 if you have any questions or need assistance.

     

    Sincerely,

    Demetrise Cooley, Director

    Achievers Upward Bound Math & Science

     

    Who is Eligible to Participate in the Program?

    • Are currently enrolled at Humphreys County High School or Yazoo City High School
    • At least 13 years of age but not older than 19
    • U.S. citizen or permanent resident
    • First-Generation (a student whose parent did not complete a 4-year college or university degree)
    • Meet the low-income requirements as defined by the Federal Government
    • An individual who has a high risk for academic failure

     

    Free Services Offered by the Upward Bound Math & Science Program

    Preparation of Educational Plans

    Academic Advisement

    Career Exploration

    Information on Post-Secondary Education

    Financial Aid (FAFSA) Assistance

    American College Test (ACT) Prep

    Tutoring (FREE)

    College Campus Tours

    Cultural Enrichment Activities

    Six-Week Summer Camp Program

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    • Student Application  

    • Instructions for completing this form:

      1. Read each question carefully and complete all sections by writing in black or blue ink or typing on the computer.

      2. If you fail to answer all necessary questions and/or omit signatures, your application will be returned to you for completion.

      3. Students cannot participate in program activities until all application materials are complete and returned to the address above.

      4. If you are under the age of 19, you and your parent or guardian must sign all application materials.

      ***The information you provide on this application will be secure and confidential***

    • Student Information: 
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    • Disconnected Youth/At Risk Students:

      “Disconnected Youth” is defined as individuals between the ages of 14 and 24 who are homeless, in foster care, involved in the juvenile system, or neither employed nor enrolled in and educational institution.

    • Parent/Guardian Information: 

    • First Generation Eligibility Verification

    • FIRST-GENERATION CERTICATION STATEMENT

      Completing this form, which will serve as a statement of Educational attainment, you are certifying that the information submitted regarding parent/guardian educational attainment is true to the best of your knowledge.

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    • Income Verification Information

      As a federally funded free program for students. Upward Bound & Upward Bound Math & Science is required to verify income levels.

    • INCOME CERTIFICATION STATEMENT

      By completing this form, which will serve as a statement of income, you are certifying that the information submitted regarding the family size and taxable income is true to the best of your knowledge.

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    • School Record Release, Waiver to Provide Services, and Post-High School Tracking Release 

      By signing here, I understand that as a part of the Jackson State University Achievers Upward Bound Math & Science Program selection process, my child’s school records including transcripts, progress reports, standardized test scores, attendance records, disciplinary actions, evaluations, and medical records will be examined. I also understand that if my child is selected for the Jackson State University Achievers Upward Bound Math & Science Program. The Achievers Upward Bound Math & Science Program will continue to require this information from my child’s high school and college. This information is necessary to track the performance of the Program’s participants and graduates. I hereby give permission for Jackson State University Achievers Upward Bound Math & Science Program to request the above information from my child’s high school and future colleges that he/she may attend.

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    • Certification of Application and Information Release

      I (We) certify that the information provided on the application is true and correct to the best of my (our) knowledge; I (We) further understand that the completion of this application does not guarantee acceptance into the JSU Achievers Upward Bound Math & Science Program. I (We) also authorize the use of my (our) image and name in JSU Achievers Upward Bound Math & Science publications, editorials, advertisements, and media releases to the program and its affiliates organizations. My (Our) consent will remain in effect until I (we) revoke this authorization, in writing, with the JSU Achievers Upward Bound Math & Science office.

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    • Applicant Essays

      Both essays must be completed by the applicant with a minimum of five (5) sentences.

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