University Of Central Florida-ACE-UB-Application Form

Student Grade Level:

DOB:

mm-dd-yyyy

Age:

Full Name:

First NameMILast Name

Street/Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone:

(999)999-9999

Cell Phone:

(999)999-9999

May we contact you via text/call?

Gender (circle one):

Other

Email (Personal Email Address):

example@example.com

Race (check ALL that apply):

Ethnicity (check only one):

Hispanic, Latino, or Spanish:

Are you a ward of the court, in foster care, or adopted?

(If yes, please provide documentation)

Have you previously participated in a Federal TRIO Program?

If yes, list the program:

Optional Information: Do you have a disability?

If yes, please list:

Are you a US Citizen?

If not, Permanent Resident Alien?

A# (optional):

Do you plan to attend college?

Other

Which do you plan to enroll in after High School?

Parent/Guardian's Full Name

First NameLast Name

Who does the applicant/student live with?

Parent/Guardian #1

Home Number:

(999)999-9999

Cell Number:

(999)999-9999

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address:

example@example.com

Parent/Guardian #2

Parent/Guardian’s Full Name

First NameLast Name

Home Number:

(999)999-9999

Cell Number:

(999)999-9999

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address:

example@example.com

Has either parent received a 4-Year Bachelor’s Degree?

If yes, specify:

Check any services your family receives:

IF YOU FILED A TAX RETURN:

1. Number of family members:

2. Total TAXABLE income: $

Name:

First NameLast Name

Signature:

Date:

mm-dd-yyyy

IF YOU DID NOT FILE A TAX RETURN:

1. Number of family members:

2. Family household income: $

Support sources:

Name:

First NameLast Name

Signature:

Date:

mm-dd-yyyy

TRACKING:

I hereby give permission for the UCF Upward Bound Program to retrieve, store, and report education verification information and student outcomes research from the National Clearinghouse and other services.

RESEARCH:

I grant permission for the UCF Upward Bound Program to collect and report pertinent information for ongoing TRIO Center research. Only aggregate data will ever be published.

MEDICAL RELEASE:

If medical services are needed during program activities or field trips, I authorize necessary treatment.

RECORDS RELEASE:

I authorize UCF Upward Bound to request transcripts, grade reports, test scores, contact information, and academic records from all schools through college graduation. Records will remain confidential.

ACTIVITY AND FIELD TRIP AUTHORIZATION/RELEASE:
I release the University of Central Florida and its representatives from liability for my child during UCF Upward Bound activities and travel.

PHOTO RELEASE:

I authorize the UCF Upward Bound Program to use my child's image in photos or videos for program publications without compensation.

By my signature below, I agree to and fully understand all the above conditions.

Student Name:

First NameLast Name

Parent/Guardian Name:

First NameLast Name

Parent/Guardian Signature:

Date:

mm-dd-yyyy

UCF TRIO Project ACE Application

SECTION 1: STUDENT INFORMATION

SECTION 2: STUDENT NEEDS/INTERESTS ASSESSMENT

SECTION 3: PARENT INFORMATION

SECTION 4: FIRST-GENERATION ELIGIBILITY

SECTION 5: PARENT/GUARDIAN INCOME VERIFICATION

SECTION 6: STUDENT PERSONAL INFORMATION & AUTHORIZATIONS