NC State University Upward Bound Programs 2026-2027 Admission Application

2026-2027 PROGRAM APPLICATION

NC State University TRIO Upward Bound 2026-2027 Admissions Application

NC State University TRIO Upward Bound (UB) Programs strive to encourage educational opportunities for high school students by providing academic and personal support to enhance academic skills, increase promotion and graduation rates resulting in post-secondary (college) enrollment. TRIO Upward Bound provides opportunities for academic and personal development by assisting students with high school course selection, tutoring, cultural activities, motivating students toward the successful completion of their secondary (high school) education and promoting post-secondary (college) enrollment through individualized coaching, programming, and tutoring, at no cost to the student.

INSTRUCTIONS: To complete the application you must have your taxable income
data. Incomplete applications cannot be saved.

Program Eligibility

Qualifying for participation in the TRIO Upward Bound Programs is competitive.

Interested students must be:

1. A citizen or national of the U.S. or meets the residency requirement for Federal
   student financial assistance
2. A student must be enrolled, at one of the five target schools (Vance County HS, Bunn HS, Louisburg HS, Franklinton HS and East Wake HS)
3. A student must have a need for academic support, as determined by NC State
   University TRIO Upward Bound Programs, in order to pursue successfully a post-secondary educational program
4. And the student meets the following criteria:
   
   1. Income Requirements based on federal guidelines (Taxable Income).
   2. 1st-generation college student (neither parent or guardian has received a 4-year college degree)

FIRST-GENERATION

A first-generation college student is defined an individual neither of whose natural or adoptive parents received a baccalaureate degree; or a student who, prior to the age of 18, regularly resided with and received support from only one natural or adoptive parent and whose supporting parent did not receive a baccalaureate degree. (34 CFR 645.6)

Income Verification

Documentation of Household Size and Taxable Income is required to determine financial eligibility for participation in the TRIO Upward Bound Programs. Please use the most recent year income data to complete the income verification information below.

What is your family's TAXABLE INCOME status from the most recent year?

Read the following statement and sign:

My signature certifies that the above information is correct. I understand that this
information is confidential and will only be used for income verification for this program.

NC State University TRIO Pre Collegiate Programs Release of Information

INFORMATION RELEASE FORM

The information requested on this form will be utilized to assist us in providing services to you. In order to provide the most effective services, we may need to obtain information from several sources: such as high schools, colleges, testing agencies, counselors, admissions and financial aid officers and social workers etc.

ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE
WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT.

My signature below authorizes the NC State Upward Bound Programs to:

1. Request a copy of my high school and/or college transcript, test scores and/or documentation of grade promotion or graduation.
2. Request a copy of my financial aid applications and awards from the Federal Government, state funding agencies and post-secondary institution.
3. Request a copy of my test score reports (ACT, SAT) from the American College Testing Program, College Board and Educational Testing Service.
4. Communicated with representatives from agencies or post-secondary institutions on my behalf.

AUTHORIZATION STATEMENT

I hereby authorize the NC State University Upward Bound Programs to contact and request information forms, as well as, to supply information to the above-mentioned parties.

Photograph and Publicity Release

I give permission to NC State University to take and publish photographs, video, audio or other impressions of my image or voice (collectively “photographs”). I understand that I will not be compensated for any photographs or other likeness that may be used in this capacity.

I give permission for my photographs or other likeness to be used by NC State and its affiliates without compensation for noncommercial news, advertising, publications, editorial, promotions and/or any other purpose in print and electronic media (including the World Wide Web) and to copyright the same. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other
compensation arising from or related to the use of the photograph.

I expressly release NC State, its agents, officers, licensees and assigns from any and all claims which I may have for invasion of privacy, right of publicity, defamation, copyright infringement or any other causes of action arising out of the use, adaptation, reproduction, distribution, broadcast or exhibition of such photographs.

I have read the foregoing, and I fully understand the contents, meaning and impact of this release.

NC State University Health Release & Liability

MEDICAL INFORMATION

Please list any and all physical conditions that your student may have which might affect or be affected by participation in this program and which the Upward Bound Staff should know.

MEDICAL RELEASE FORM

A student in the Upward Bound Program

I do hereby grant permission to the Director of Upward Bound, or the Director's authorized representative, to furnish first aid as my child (named above) may require, as well as to seek medical attention through the nearest medical facilities such as those provided on campus and those medical facilities available when students are on field trips and other authorized activities.

This permission is conditioned upon the understanding that, in the event of serious illness or the need of hospitalization and/or major surgery, the Director will use all reasonable efforts to contact me. Failure in such effort, however; should not prevent the Director from providing such emergency treatment as may be necessary for the best interest of the life of my child. A photocopy of this permission is to be considered as valid as the original. I further understand that treatment for any medical problems my child may suffer is my responsibility and will be paid by me and/or covered by my insurance.

LIABILITY WAIVER, ASSUMPTION OF THE RISK, AND INDEMNIFICATION AGREEMENT FOR NC State University PROGRAM

In consideration for being allowed by NC State to participate in the Upward Bound Programs (hereinafter “Program”) the undersigned custodial parent/guardian hereby agrees as follows:

I do hereby affirm and acknowledge that my child is participating in the Program for his/her own personal benefit, and have been fully informed of the inherent hazards and risk to them associated with this activity including property damage, falls, contact with other participants, motor vehicle accidents, sprains, and other personal injuries. I accept and assume responsibility for all risks, known and unknown, involved to my child and their property in the aforementioned activity, and I voluntarily authorize my child’s participation in reliance upon my own judgment and knowledge of my child’s experience and capabilities.

I understand that the determination of my child’s ability to participate in the Program should be made by my child’s physician if necessary. I understand that I need the approval of a physician if I am uncertain as to his/ her physical fitness for the rigors of this Program. I understand that I may be required to seek approval from a physician if there is a health or safety question relative to my child’s condition, before being allowed to participate in the Program. In addition, I give permission to any doctor, hospital, or other medical facilities to release confidentially to their treating physician(s) for my child any information they may have concerning his/her medical condition and their professional contact with him/her for treatment purposes. I hereby grant my permission for such diagnostic, therapeutic, and operative procedures as deemed necessary for my child. A photocopy of this permission is to be considered as valid as the original. I further understand that treatment for any medical problems my child may differ is my responsibility and will be paid by me and/or covered by my insurance.

I shall indemnify and hold harmless NC State University, its trustees, officers, employees and agents from any liability, losses, costs, damages, claims or causes of action of any kind or nature whatsoever, and expenses, including attorney fees, arising from or proximately caused by my child’s participation in this Program, and including any travel. I further agree to accept and assume for myself, my assigns, executors, and heirs any and all such risks and losses that may occur.

I have read the Program’s rules and regulations and hereby accept the regulations of the Program described therein. I understand that the Program has the authority to establish and enforce other regulations in addition to these.

I understand that this is a legal document which is binding on me, my heirs and assigns and on those who may claim by or through me. I am eighteen years of age or older, and have full capacity to enter into this agreement and do so voluntarily.

I HAVE READ THIS AGREEMENT, I UNDERSTAND IT AND I AGREE TO BE BOUND BY IT.

I attest to the fact that the above information is true and accurate to the best of my knowledge.

I understand the purpose of the Upward Bound Program is to prepare participants to
successfully complete a program of post-secondary education. As part of my personal efforts in this preparation, I commit to Upward Bound through completion of the Bridge Program and intend to participate in all academic year and summer components of the program.

I understand that attendance is an integral part of participating. Therefore, I agree to attend and actively participate in all classes, meeting, and activities sponsored by Upward Bound. I will comply with all rules and regulations of the Upward Bound Program, and I am aware that failure to comply could result in dismissal from the program.

TEACHER / COUNSELOR RECOMMENDATION 

A full student application must have a teacher or counselor recommendation. Please complete the section below with your recommender's contact information. They will automatically be sent the electronic recommendation form once you submit your application. Please check to make sure they received it and that they complete it. Please make sure that their email address is correct.