Dear Student Applicant,
Thank you for your interest in the Missouri State University Upward Bound Program. Before completing the Upward Bound application, it is important to read and understand what being an Upward Bound participant is all about. The purpose of Upward Bound is to assist students in the development of academic skills and motivation necessary to succeeding both in high school and beyond. Through academic tutoring and instruction, the Upward Bound Program assists participants with high school study and encourages them to pursue a college education. On selected Saturdays, students, tutors, and staff meet for sessions called “Destined for College” meetings.
Upward Bound is a federally funded TRiO program that works with 50 students from three target high schools in the city of Springfield. Participants are students from one of the following high schools who are interested in sharpening their academic skills and pursuing education after high school graduation. Participants come from these high schools: Central, Hillcrest, and Parkview.
Upward Bound activities must be taken seriously by each participant. Students who are admitted agree to take part in both the academic year and six-week summer program. These important components have the following objectives:
o To increase academic performance of program participants.
o To assist participants in developing motivation to succeed in high school and attend college.
o To provide informative and enriching educational opportunities for all participants.
o To encourage participation in cultural/educational experiences beyond those available at their high schools.
o To provide tutoring, career exploration, and college advising to participants.
o To provide assistance in securing admission to a postsecondary institution and guidance in acquiring financial aid.
We are grateful for the support of the university, the U.S. Department of Education, the area public school system, the community, and our educational partners. We are confident that we can and will continue to help address the academic needs and challenges of our students.
Sincerely,
TaJuan R. Wilson, MPA
Director, TRiO Programs
Missouri State University
(417) 836-6220
About the Upward Bound Program….
The Missouri State University TRiO Upward Bound Program is a pre-college program administered by the U.S. Department of Education and is designed to motivate and prepare high school students for postsecondary education. The program serves 50 students in 9th through 12th grades at Central, Hillcrest, and Parkview high schools. Students who are accepted into the program remain in the program until graduation from high school or until the student is released from the program, either voluntary or involuntary.
Priority is given to applicants whose economic status or taxable income meets the Federal TRIO Income Guidelines (see second page of Part III: Parent/Guardian Information) and who demonstrate academic need. Although grades are important, they are not necessarily used in determining whether or not a student is eligible for Upward Bound; throughout the program, students must demonstrate academic potential.
The following is a brief outline of the services that a student will receive through Upward Bound:
Academic Year Component (September-May):
§ Tutoring sessions at your high school (Frequency depends on GPA)
§ Meeting with site coordinator once per month at your high school
§ After School Meetings twice per month at your high school
§ Various activities in Springfield and at Missouri State University
§ Saturday Destined for College Meeting once per month at Missouri State University
o Includes career, college, cultural and academic activities
Summer Component (June-July):
§ High school-level instruction (Monday-Thursday for six weeks) at Missouri State
o Classes include Math, Science, Languages, English, Social Sciences, and Electives
o Lunch
o Evening activities
o Fun Fridays-includes trips, college tours, seminars, sports, and other activities
§ Possible out-of-state Cultural/Educational Trip
Year-Round Services
§ Personal, academic and career counseling/advising
§ Stipends-monetary rewards given to students for participation
o Up to $40 per month during the academic component
o Up to $60 per month during the summer component
§ ACT/SAT Preparation
§ College Tours
§ Field Trips
§ Financial Aid and Scholarship Education
All expenses for participating in the Upward Bound programs, activities and events are paid for by the Program.
For more information, please call (417) 836-6220.
Name
(Last) (First) (Middle)
Address
Street Address or PO Box City State Zip Code
Phone /Alt: Email
High School Grade
Date of Birth Place of Birth
Social Security # Gender Male Female
(If you do not have a Social Security number, please check here. )
Ethnicity (This information is optional Marital Status (check one)
and will be used for reporting purposes only.) Single (never married)
African American Married
Hispanic/Latino Divorced
Native American/Native Alaskan Widowed
Asian
Native Hawaiian/Pacific Islander
Caucasian
Multiracial (please specify)
Other (please specify)
US Citizen? Yes No Resident Alien? Yes No
Alien Registration #A
Ø Have you ever applied to an Upward Bound Program before? Yes No
Ø Have you ever been a member of an Upward Bound Program? Yes No
Exam Information
Have you taken the PSAT? Ο Yes Ο No If yes, please state date taken:_____ / score: _____
Have you taken the SAT? Ο Yes Ο No If yes, please state date taken:_____ / score: _____
Have you taken the ACT? Ο Yes Ο No If yes, please state date taken:_____ / score: _____
Have you taken the ACT Plan? Ο Yes Ο No If yes, please state date taken:_____ / score: _____
Student Goals
What is your career interest?
Do you plan to attend college? Ο Yes Ο No
Do you want to attend college? Ο Yes Ο No
If yes, which college(s) are you interested in attending?
Student Interests
What are your hobbies and/or interests?
What school activities, clubs or other extracurricular activities in which you participate?
What is your favorite subject? Least favorite?
What is the title of the last book you read that was not assigned to you by a teacher?
Why do you want to join the Missouri State University Upward Bound Program? (Check all that apply.)
Academic support/enrichment Tutoring services
Personal support/counseling Encouraged to apply by family
Career counseling Field trips
Assistance with college admission Destined for College Meetings
Assistance with financial aid Assistance with the ACT/SAT
To make friends Other
Parent/Guardian Information
Note, this information is necessary for determining program eligibility
and is required of all families whose children are served by the Upward Bound Program.
Your cooperation is needed in filling out the information completely
Student lives with: Mother & Father Foster Parent(s)
Mother only Guardian(s)
Father only Other (specify)
FIRST GENERATION ELIGIBILITY VERIFICATION –All information is kept confidential!
INCOME ELIGIBILITY VERIFICATION –All information is kept confidential!
PART IV: INFORMATION RELEASE FORM
Student’s Name High School
SSN Current Grade: 9 10 11
I hereby give the Missouri State University TRIO Upward Bound Program permission to receive copies of educational records and other materials necessary for participation in the Program. Further, permission is granted to request academic and financial aid information and records from any and all postsecondary institution is order to track college progress. I understand all of my records will be kept in confidence and in accordance with the Privacy Act of 1974.
You have our consent to release grades, test scores, and any other academic records to the Missouri State University TRIO Upward Bound Program.
(Student’s Signature) (Parent’s Signature) (Date)
Application Checklist:
Part I: Student Information
q Are all appropriate boxes and blanks filled in completely (if a question does not apply to you, please write “none”)?
q Did you sign the appropriate fields?
Part II: Personal Statement
q Did you include your personal statement in the exact format requested?
q Did you answer all of the questions and complete all five paragraphs?
Part III: Parent Information
q Are all appropriate boxes and blanks filled in completely?
q If your parents filed an income tax return last year, did you include a copy?
q If your parents did not file an income tax return last year, did you fill out your income information in the appropriate box?
q Did your parents/guardians sign the application?
Part IV: Information Release Form
q Are all appropriate boxes and blanks filled in completely (if a question does not apply to you, please write “none”)?
q Did both you and your parents/guardians sign the appropriate fields?
Finally:
q Did you make a copy of this application for your records?
If the answer is “yes” to all of these, you are ready to submit your application! You may turn it in to your high school’s site coordinator (Central – Ms. Simmons; Hillcrest – Ms. Schirk; Parkview – Ms. Maynard) OR send it directly to the Missouri State University TRIO Upward Bound Office at 901 S. National Ave., Springfield, MO 65897, or fax it to our office at 836-6106. Please call 836-3117 or email upwardbound.missouristate.edu if you have any questions.
After submitting the application, we will process it and then contact you to schedule an interview with you and your parents/guardians. If you have questions in the meantime, please contact our office.
Thank you for filling out our application!
PART V: GUIDANCE COUNSELOR RECOMMENDATION
This student has applied to participate in the Missouri State University TRIO Upward Bound Program. The information requested will help us in determining the student’s eligibility to participate. Please complete this portion of the form adding appropriate comments as needed.
Student’s Cumulative GPA Student’s Class Rank
Attendance Record Excellent Good Fair Poor
Student’s motivation for enrolling in postsecondary education High Middle Low
Please select the subject areas in which you feel this student has an academic need (please include courses in which the student needs credit or subjects in which the student would benefit from enhancement):
Writing Reading Math
Science Foreign Language History
Career Information Self-concept Educational planning
Other (please specify)
Does this student have limited English proficiency? Yes No
Was/Is this student enrolled in any Advanced Placement course(s)? Yes No
If yes, which one(s)?
Please give your perception of this student’s academic potential. Include academic, social and family factors:
Important! Please return a copy of the following with this form:
1. Student’s official high school transcript
2. Student’s most recent report card
3. A printout of student’s 7th grade state test scores
4. A copy of student’s middle school academic record
Please sign below and attach this form to the other required forms. Insert all forms in an envelope. Please seal and sign the edge of the flap of the envelope and return to the student or fax the information to Upward Bound at (417) 836-6106.
Name of person completing this form Title
Signature Date
PART VI: FACULTY RECOMMENDATION
To be completed by a teacher who has had this student enrolled in their class within the past year.
Student’s Name High School
Current Grade 9 10 11
Your Name Title
Your Phone Number Your E-mail
Length of time you have known student
Excellent PoorHas good class attendance / 1 2 3 4 5
Demonstrates punctuality with assignments / 1 2 3 4 5
Seems motivated to achieve in class / 1 2 3 4 5
Demonstrates good study habits / 1 2 3 4 5
Accepts responsibility for his/her work / 1 2 3 4 5
Demonstrates a good work ethic / 1 2 3 4 5
Demonstrates good communication skills / 1 2 3 4 5
Cooperates with peers / 1 2 3 4 5
Appearance/behavior reflect a positive self-image / 1 2 3 4 5
Exhibits dependable and reliable behavior / 1 2 3 4 5
Respects authority / 1 2 3 4 5
Student’s potential for postsecondary success / 1 2 3 4 5
From which components of the program do you feel the student would benefit the most?
____Destined for College Meetings Personal counseling/support
____Career advising/exploration College student mentor
____Adult professional mentor/job shadowing ACT preparation
____Field trips (college campuses, cultural events, etc.) Tutoring
Comments:
Would you recommend this student for the Missouri State University TRIO Upward Bound Program?
Highly recommend Recommend with reservation Not recommend
Comments:
Please sign below and insert into an envelope.
Please seal and sign the edge of the flap of the envelope and return to the student,
or send to Missouri State University TRIO Upward Bound, 901 S. National Ave., Springfield, MO 65897,
or fax the information to Upward Bound at (417) 836-6106.
FACULTY SIGNATURE DATE