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ABOUT UPWARD BOUND

The Upward Bound (UB) TRiO program is funded by the U.S. Department of Education, and has served northern Arizona high school students since 1977. UB is a year-round program designed to increase participant’s high school graduation rates, prepare students academically for college, assist them with college enrollment/admission, and enroll/retain students in college until they earn an Associates or Bachelor’s degree. UB provides intense academic, career, personal, and financial advising, cultural leadership activities, college campus tours, and academic instruction in language arts, speech communication, mathematics, and science.

PROGRAM ELIGIBILITY

Upward Bound participants must meet the following criteria in order to be considered for the program:

1. Be a citizen, national, or permanent resident of the United States
2. Meet at least one of the need-based criteria:
   1. Meet family income guidelines as set forth by the federal government
   2. Be a first generation student (no parent/guardian has earned a four-year college degree).  
3. Be enrolled at one of the four target high schools:
   1. Coconino High School
   2. Flagstaff High School
   3. Williams High School
   4. Winslow High School

PARTICIPANT REQUIREMENTS

If selected into the program, freshmen participants must commit to the following:

1. Meet with Upward Bound Staff during our monthly site visits to the target high school
2. Complete two (2) freshmen portfolio assignments in the Spring semester
3. Attend Upward Bound Conference Day (Late March)
4. Attend Upward Bound Freshmen Day (Early April)
5. Complete the four (4) week residential Academy at Northern Arizona University in June
   1. Upon successfully completing Academy, students receive one high school elective credit

WHAT TO EXPECT FROM THE UPWARD BOUND APPLICATION?

Successful Upward Bound applications require advanced preparation to be fully completed and considered. Students and their Parent(s)/Guardian(s) need to ensure they have responses ready to the following components of the application. Please note that you may always SAVE the application using the button at the bottom of each page!

1. Three (3) STUDENT Essay Questions (300 Word Count Max Per Question)
   1. Introduce yourself, your family, and share your personal interest(s).
   2. What are your academic goals and future plans?
   3. What obstacles may you encounter when enrolling, attending, and graduating from college?  How will you overcome these challenges?
2. Three (3) PARENT Essay Questions (300 Word Count Max Per Question)
   1. How would you describe your child, and their academic strengths and weaknesses?
   2. How have you helped your child be successful when it comes to their education?
   3. How much support can we expect from you in regards to your student’s involvement in the Upward Bound program?

APPLICATION DOCUMENTS CHECKLIST

As a federally funded program, Upward Bound must collect certain documentation to verify we are serving those who are eligible for the program. As such, please make sure the following documents are ready in ELECTRONIC FORMAT prior to filling out the Upward Bound Application:

• One of the following Income Verification documents
  1. SIGNED Copy of Parent(s)/Guardian(s) 2023 FEDERAL Income Taxes (Only page 1 & 2)
  2. If 2023 taxes were not filed, please complete the Parent/Guardian 2023 Income Affidavit included in the Upward Bound application
• Copy of student’s Social Security Card or Alien Registration Card (Green Card)
• Copy of student’s Certificate of Indian Blood (CIB), if applicable
• Copy of Family Health Insurance Card

The student’s name as it appears on their birth certificate.

What pronouns should someone use when they speak about you in the third person? For example, Joe has completed HIS Upward Bound application but Jill has not completed HER application.

If this person does not have a cell phone, please put the best number to reach this person.

UPWARD BOUND IS A FEDERALLY FUNDED PROGRAM. THE FOLLOWING INFORMATION IS REQUIRED TO BE COLLECTED PER FEDERAL FUNDING GUIDELINES.

The sex listed on your birth certificate

Only enrolled students from the listed high schools are eligible for participation in NAU Upward Bound.

If this person does not have a cell phone, please put the best number to reach this person.

Instructions:
Complete this form only if you DID NOT file a 2023 Federal Income Tax Return (form 1040, 1040A or 1040EZ).  If you are separated or divorced, use your income only.  If you are remarried, include your spouse's income, and designate as step parent income. Please give yearly income for 2023 tax year only (1/1/23 - 12/31/23).

Certification:  All of the information on this form is true and correct to the best of my (our) knowledge.  If asked by an authorized official, I (we) agree to give proof of the information that I (we) have given on this form.

The student and parent essays are an important part of the selection process.  Take your time and submit your best work. 

Student and parent essay responses must meet the following requirements:   

• Complete sentences 
• Proper spelling and grammar
• 1 – 2 paragraphs per question (300 word count)
• Essay responses must be typed 

Student Questions

Parent (Guardian) Questions 

Thank you for taking the time to fill out our various forms & waivers! Having this information on file is crucial to the success of your student in the Upward Bound program. By completing these forms online, you will be GREATLY REDUCING the number of forms you will need to fill out for your student during the program year!

Please note these authorizations only last until the end of this academic year and will need to be renewed for Upward Bound Academy and the next academic year. Additionally, should Upward Bound partner with outside organizations (such as Grand Canyon Youth) you may be required to fill out additional forms as required by their terms & conditions.

Finally, please note this is NOT signing up your student to participate in ALL Upward Bound activities and events. Rather, completing these forms legally authorizes your student to do so. Upward Bound will send out separate (but short) registration forms so you and your student can sign-up to participate in the events and activities as desired.

Please reach out to an Upward Bound staff member if you have any questions or concerns in completing these forms. ALL Upward Bound participants must have these forms on file to participate in the program

Program Information & Details

Program Description:

Upward Bound is a federally funded program that provides low-income and first generation high school students with the tools and resources to pursue a postsecondary education. In pursuit of this mission, Upward Bound hosts a variety of programs, activities, events, etc. to assist our students. These programs include (but are not limited to):

• Upward Bound Academy (June & Early July)
• Portfolio Meetings (Academic Year)
• Portfolio Program Orientation (Late August/Early September)
• Community Garden Events (September/October)
• College Tours (October - Typically One in the Fall Semester)
• College Access Workshop (Fall Semester)
• Conference Day (March)
• Freshman On-Campus Day (April)
• Miscellaneous Outdoor Adventures (Varies - Typically One Per Semester)
• Miscellaneous Academic Events (Varies)

Department Contact:

Diana Betoney | UpwardBound@nau.edu | (928) 523-6984

Program Location:

Varies. See below event examples for sample locations that are subject to change.

• Upward Bound Academy (NAU Campus - Assigned Campus Living Community)
• Portfolio Meetings (Student's High School)
• Portfolio Program Orientation (Student's High School)
• College Access Workshop (NAU Campus - Cline Library)
• Community Garden Events (Southside Community Gardens - Flagstaff, AZ)
• College Tours (Varies by Year - Typically One in the Fall Semester)
• Conference Day (NAU Campus - High Country Conference Center)
• Freshman On-Campus Day (NAU Campus - Health & Learning Center)
• Miscellaneous Outdoor Adventures (Varies by Year - Typically One Per Semester)
• Miscellaneous Academic Events (Varies by Year - Typically One Per Semester)

Specific Potential Risks to Participants:

Most Upward Bound Activities have few to no risks associated with participation. Typical risks for activities that involve travel include those associated with motorized land and air travel. Typical risks for activities that involve physical activity are athletic injuries such as musculoskeletal, bruises/cuts/abrasions, difficulty breathing, etc. Every effort is made to reduce risks while participating in the Upward Bound program.

THIS DOCUMENT HAS LEGAL CONSEQUENCES, IT MUST BE COMPLETED AND SIGNED PRIOR TO PARTICIPATION. PLEASE READ IT CAREFULLY BEFORE SIGNING.

If not defined within the form, all capitalized words shall have the meaning as set forth in the Northern Arizona University Supervision of Non-Student Minors Policy.

This NAU form is collected per state law and institutional policy for liability reasons. The information may be shared with the NAU Contracts, Purchasing, and Risk Management office as a matter of record. Questions about the information being requested can be directed to (928) 523-4557 or NAU-Insurance@nau.edu.

Emegency Contact Information

Minor may be picked up at the end of the Program or for any authorized time spent off of campus by any of the following people:

Authorized Pick Up

Identification will be required to be shown to Program staff by the person who is picking up the Non-Student Minor. If the parent(s)/legal guardian(s) listed above is not the person picking up the Non-Student Minor, add name(s), relationship(s), and phone number(s) of other authorized individuals below.

Minor will be picked up at the end of the Program or for any authorized time spent off of campus by:

Parent/Guardian Agreement

I affirm that I am the adult parent or legal guardian of {main_name}, a Non-Student Minor under the age of eighteen (18), and I consent to their participation in this Program. In consideration of allowing Minor to participate in this Program and related activities, I, on behalf of Non-Student Minor and for myself and my spouse, if any, and our heirs, successors, and assigns:

1. Acknowledge and understand that allowing Non-Student Minor to participate in the Program may involve a variety of activities. Such participation, particularly in field trips, “wilderness trips,” sports camps, and physical education, may involve risks, including but not limited to, serious personal injury, partial or permanent disability, sickness, disease or illness, property damage, and/or death. These risks may result from Non-Student Minor’s own actions or inactions, from the actions or inactions of others, or may be inherent to participating in the Program. I understand that I am responsible for ensuring that Non-Student Minor is properly prepared for all Program activities, and I represent that Non-Student Minor is in good health and is able to participate fully in all Program activities. If the Program is an on-line activity, risks include but are not limited to, data mining, phishing, viruses, malware, data breach of on-line information, cyberbullying, exploitation, cyber stalking, on-line grooming, cyber predators, and image replication. Knowing these risks may occur in an on-line Program, I choose to have Non-Student Minor participate in the Program. I also understand that Northern Arizona University is not an agent of and has no responsibility for any third party that may provide any services during the Program, including but not limited to, food, lodging, travel, and equipment associated with the Program. I acknowledge that Northern Arizona University has taken enhanced health and safety measures, in accordance with guidelines from the U.S. Centers for Disease Control and Prevention, in response to the COVID-19 pandemic. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. By allowing Non-Student Minor to attend the Program at Northern Arizona University, I voluntarily assume all risks related to Non-Student Minor’s exposure to COVID-19.
2. Assume all of the foregoing risks and accept personal and financial responsibility for all damages for personal injury, partial or permanent disability, property damage, or death of Minor, or caused by Minor, to the fullest extent allowed by law.
3. Agree not to sue the State of Arizona, the Arizona Board of Regents, Northern Arizona University, their officers, employees, agents, and assigns, and waive all claims, demands, losses, or damages on account of personal injury, partial or permanent disability, property damage, or death, caused or alleged to be caused in whole or in part by the actions of any person or entity, to the fullest extent allowed by law.
4. Grant to Northern Arizona University and to its employees, agents and assigns the right to photograph and use the photo and or other digital reproduction of them or other reproduction of their physical likeness for publication purposes for use in connection with Northern Arizona University Programs, whether electronic, print, digital or via the Internet, so long as I have signed the Non-Student Minor Release Form.
5. Understand that the only medical treatment that will be provided by the Program is for such things as minor scrapes and bruises. Any medical costs, including emergency medical treatment that may be incurred as a result of Non-Student Minor’s participation in the Program will be my financial responsibility. I further understand that medical care facilities may not be immediately available and I accept the increased risk in the event of injury or death.
6. Hereby consent to Northern Arizona University and any appropriate medical facility, and/or to the physician(s) listed below, providing whatever medical services they may deem necessary for Minor in the event of an emergency. I certify that I have adequate insurance and/or other means to pay for any costs and expenses related to these services and I agree to bear such costs and expenses in full.
7. Agree to review Program rules with Minor and agree Minor will comply with Northern Arizona University rules, standards, as well as any specific standards of conduct of the Program that may be provided. I understand that Non-Student Minor is not permitted to consume alcohol, possess/use weapons or illegal substances, or engage in sexual activities while participating in the Program. I understand Non-Student Minor may be removed from the Program for misconduct or failure to follow rules or instructions of Northern Arizona University or for any behavior detrimental to or incompatible with the standards of Northern Arizona University or the Program, and I understand that in that event I may not be entitled to a refund of any or all Program fees and costs.
8. Waive and release all claims against the State of Arizona, the Arizona Board of Regents, and Northern Arizona University, their officers, employees, agents, and assigns that arise at a time when Non-Student Minor is not under the direct supervision of Northern Arizona University or that are caused by Non-Student Minor’s failure to remain under such supervision or to comply with rules or instructions, to the fullest extent allowed by law.
9. Acknowledge and understand that either the Non-Student Minor or Northern Arizona University has the right to decline, decrease, or cease Non-Student Minor’s participation in the event of illness, injury or other medical condition.
10. Understand that Northern Arizona University may reduce or stop Non-Student Minor’s participation, in its sole discretion, in the best interest of safety or to aid in the well-being of other participants. Northern Arizona University may require further assessment and medical clearance from a physician prior to participation in the Program.
11. ACKNOWLEDGE THAT I HAVE CAREFULLY READ THE ABOVE ASSUMPTION OF RISK, WAIVER, RELEASE, AND CONSENT FOR NON-STUDENT MINOR PARTICIPATION FORM AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY.
12. No oral or written representations can or will alter the contents of this document. I agree that this document shall be governed by the laws of the State of Arizona.

Miscellaneous NAU Policy Agreements:
Please take the time to read through the following NAU policies as minor’s must abide by all NAU policies, procedures, and protocols. This list is provided in an effort to highlight the most relevant policies to Upward Bound Participants but is in no way meant to be an exhaustive list. A comprehensive source of all NAU policies can be found online via the University Policy Library. By signing this form, you agree that your minor will abide by all NAU policies.

• Supervision of Non-Student Minors
• Student Code of Conduct
• Campus Living Community Policies
• Appropriate Use of Information Technology Resources
• Jackscard Terms and Conditions
• Campus Recreation Policies (includes Climbing Wall Agreement)

 

Medical Information

 

Provide a complete and accurate statement of the physical factors that may affect participation in the Program in the fields below.

 

This NAU form outlines the behavior expected by NAU and Upward Bound of your minor while participating in our programs, events, etc. Please be sure to emphasize these expectations to your minor.

THIS DOCUMENT HAS LEGAL CONSEQUENCES, IT MUST BE COMPLETED AND SIGNED PRIOR TO PARTICIPATION. PLEASE READ IT CAREFULLY BEFORE SIGNING.

If not defined within the form, all capitalized words shall have the meaning as set forth in the Northern Arizona University Supervision of Non-Student Minors Policy.

Northern Arizona University is committed to providing a safe, enjoyable, and healthy learning environment for all Non-Student Minors involved in Programs on its campus to include virtual or on-line programs. Northern Arizona University encourages an environment of mutual respect. In order to promote the health and safety of all involved, participation by a Non-Student Minor may be terminated at the discretion of Program staff if the Non-Student Minor does not abide by these expectations.

Non-Student Minors are expected to follow all Northern Arizona University policies as well as the guidelines listed below:

1. Work cooperatively and respectfully with other Participants, volunteers, faculty, and staff.
2. Follow established Program rules and directions.
3. Use appropriate language and behavior at all times. Language or behavior that is abusive, harassing, or threatening may result in removal or suspension from the Program.
4. Use all Northern Arizona University property and materials appropriately. Charges may be incurred in the event of misuse or damage.
5. Dress appropriately for the activities as directed by Program staff, including the use of safety gear where required.
6. Remain on property where the Program is held or with the group at all times. Participants should not leave the property or group without prior notification and authorization from Program staff.
7. Obey all local, state, and federal laws.
8. Do not bring any prohibited items to Program activities and events, including for example tobacco, alcohol, drugs, illicit material, or weapons. Northern Arizona University's campus and facilities are weapons and tobacco-free.
9. Do not host guests in Northern Arizona University-owned or provided overnight accomodations without express permission from Program staff.
10. Report to Program staff any abuse or neglect committed against any Non-Student Minor during the Program.

This NAU form discloses the need for one-on-one interactions between students and staff for the programmatic purposes including but not limited to portfolio visits. You approve of these interactions by signing this form.

THIS DOCUMENT HAS LEGAL CONSEQUENCES. IT MUST BE COMPLETED AND SIGNED PRIOR TO PARTICIPATION. PLEASE READ IT CAREFULLY BEFORE SIGNING.

If not defined within the form, all capitalized words shall have the meaning as set forth in the Northern Arizona University Supervision of Non-Student Minors Policy.

Program Supervisor Information:

Name: Diana Betoney | Title: Project Director | Phone: (928) 523-6984 | Email: Diana.Betoney@nau.edu

One-on-One Interactions with Non-Student Minors Information

Describe necessity for One-on-One Non-Student Minor Interaction(s):

Upward Bound requires one-on-one meetings on a monthly basis so students and staff can discuss portfolios. Additionally, there are times during events, college tours, Academy, and other programs where authorized adults may need to give feedback to students in order to correct behaviors.

Describe the nature of the One-on-One Non-Student Minor Interactions:

All interactions will be of an educational nature with the intent of providing feedback to students to improve their academic performance and help them pursue a postsecondary education.

Describe the setting(s) of the One-on-One Non-Student Minor Interactions:

One-on-One interactions will only take place in places of business related to Upward Bound programming. This will most often be in the non-student minor's high school but can also take place on the campus of NAU and different outdoor locations for various events held.

Describe safeguards that will be implemented for One-on-One Non-Student Minor Interactions:

All staff members are trained on laws, regulations, and policies around non-student minor contacts every year. One-on-One interactions, whenever possible, will take place in open spaces with other authorized adults present during the interaction.

List of Authorized Adults that could have One-on-One Non-Student Minor Interactions:

All Upward Bound Professional Staff, Student Staff, and Target School Site Sponsors

Program Supervisor Authorization

I, Diana Betoney, authorize the above-named Program to have One-on-One Non-Student Minor Interactions between the Authorized Adults named herein and Non-Student Minors and certify all Authorized Adults have successfully completed any required training and passed required background and fingerprint screenings.

Parent/Legal Guardian Approval

I understand that the above-named Program may involve One-on-One Interaction, as defined in Northern Arizona University’s Supervision of Non-Student Minors Policy and in this form, with my Non-Student Minor and, by signing below, I authorize my Non-Student Minor to participate in the Program.

This NAU form indicates that you allow the use of images of your students by Upward Bound as a participant in the program.

The Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, protects the privacy of education records, establishes the rights of students to inspect and review their education records, and provides guidelines for the correction of inaccurate or misleading data through informal and formal hearings. This Authorization applies to the disclosure of education records.

The purpose of this Authorization is to facilitate the communication of student information to NAU Upward Bound for the purposes of assisting the student while they are in High School AND for collecting information from the Postsecondary Institution(s) they attend to fulfill annual federal reporting requirements. Generally, this information will be released without student notification; however, each institution reserves the right to notify students prior to the release of information. This release does not give authority to make changes to the student’s educational record.

By signing this Authorization, I, {parentguardianName308} and I, {studentName309},  acknowledge that my/my student’s High School and any Postsecondary Institution(s) attended are permitted to disclose information from education records to NAU Upward Bound throughout the student’s High School career and for six years after graduation from high school (per federal reporting requirements).

Records which may be released:
All educational records, including but not limited to: Financial Aid, Disciplinary, Grades, Transcripts, State Mandated Assessments, and Student Accounts. 

I, {parentguardianName308}, understand college tracking/retention of Upward Bound participants is required by the U.S. Department of Education to determine the effectiveness of the program. I am aware any information given may be released to the U.S. Department of Education, solely to determine eligibility, and measure participant/program success.

I, {studentName309}, understand the release of my educational records will be provided to the Upward Bound program at Northern Arizona University, and will be used to determine eligibility and measure participant/program success.

Click here to access and read the Upward Bound Participant Handbook.

The purpose of this Handbook is to provide our participants a comprehensive guide to navigating the Upward Bound program. This document will take you through everything from Upward Bound Academy component in the summer to the Portfolio Program component during the academic year. The information contained herein is subject to continuous review and evaluation, and Upward Bound reserves the right to make changes at any time without notice. Please reach out to staff if you have in-depth questions.

By signing this agreement, I, {parentguardianName}, and I, {studentName} acknowledge that we have carefully read the Upward Bound Handbook and agree to follow all the policies and procedures noted within.