University Of South Alabama-UB-2025 Application Form

University Of South Alabama

UB-2025 Application Form
Program Overview and Eligibility Requirements

The University of South Alabama Upward Bound Program provides academic, professional, and social support services to students attending target high schools to prepare them for college success.

Applicants must meet the following requirements:

Full Eligibility Criteria
- Qualify under the U.S. Department of Education’s guidelines as a member of a low-income household or a household in which neither supporting parent holds a baccalaureate degree.
- Meet U.S. residency requirements (citizen, permanent resident, or applied for permanent resident) and be age 14 – 19.
- Demonstrate academic need and motivation to pursue college.
- Attend one of the following target high schools: Mattie T. Blount | C.F. Vigor | Lillie B. Williamson, or provide proof that you reside within the target area of these schools.
Student Information
T-Shirt Size
Full Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
mm-dd-yyyy
Gender:*

MaleFemaleOther
Cell Phone Number:*
(999)999-9999
Email Address:*
example@example.com
Citizen Status:*

U.S. CitizenPermanent ResidentOther
High School:*
Grade Level:*

9th10th11th12th
School Counselor:*

First NameLast Name
Household Information
With which guardian(s) do you live?*

MotherFatherStep-ParentGrandparentLegal GuardianOther
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
First Parent/Legal Guardian
Name:*

First NameLast Name
Relationship to Student: *
Cell Phone: *
(999)999-9999
Does this parent/guardian have a bachelor’s (4-year) degree?*

YesNo
Second Parent/Legal Guardian
Name:

First NameLast Name
Relationship to Student:
Cell Phone:
(999)999-9999
Does this parent/guardian have a bachelor’s (4-year) degree?

YesNo
Highest Level of Education for Both Parents/Guardians:
Student Interests & Achievements
Career Field(s) of Interest:*
Honors, Awards, Leadership Positions, or Volunteer Activities (List all activities in which you participate): *
Disciplinary History
Have you served detention, suspension, or had other disciplinary issues?*

NoYes
If yes, please specify*
upload submission for transcripts and IEP

Cancelof
Financial Information

Please note that all financial information will be kept in strictest confidence and will only be seen by the appropriate USA UB personnel to determine students’ eligibility for the program.
Total number of people in household (include yourself):*
Does your family file taxes?*

YesNo
Taxable Income (after deductions): Refer to your most recent IRS 1040 Line 15 (bottom of page 1).
Tax Year Used:*
Taxable Income:*
Upload submission for 1040 Tax Year Income Form

Cancelof
Does your family receive:*

TANFSNAPSocial SecurityN/AOther
Please note that USA UB reserves the right to request and review additional documentation (including copies of your most recent tax returns). This will be determined on a case-by-case basis. You will be notified by email or phone if additional information is needed to determine financial eligibility.

If you do not file taxes, we will contact you to request further documentation.

Sign to verify income: The financial information provided is accurate. I will provide additional documentation if required
Guardian Name:*

First NameLast Name
Guardian Signature: *

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Foster Care Note: If the student is in foster care or under the care of the Division for Youth or another institution, parental income information is not required. However, written verification of the student’s status is required from the appropriate agency. Foster parents may sign the application.
Certification
We, the student and parent/guardian, affirm that all information provided in this application is accurate and complete. We understand that providing false information is prohibited and will result in immediate dismissal from USA UB.

We authorize the release of academic records (including transcripts, assessments, attendance, and behavior reports) to USA UB staff to monitor academic progress. We agree to submit the required documentation. All personal and financial information will be kept confidential and used solely for program administration in accordance with federal and university guidelines.

If selected, we agree to participate in a parent/student interview, during which the student will complete a brief personal statement. Upon admission, we commit to fulfilling all program requirements, including attending Saturday and after-school tutorials during the academic year and participating in the six-week summer program held at the University of South Alabama.
Student Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Guardian Name:*

First NameLast Name
Guardian Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy

University Of South Alabama

Student Information

Household Information

Parent/Guardian Information

Student Interests & Achievements

Disciplinary History

Financial Information

Certification