Upward Bound Application - Alabama A&M University

100% funded by the U.S. Department of Education
RY 2012 – Application
Alabama A&M University
TRiO Upward Bound Program
Official Application Packet
SUBMIT THE FOLLOWING DATA WITH SIGNED APPLICATION
I. RECOMMENDATIONS (Must submit all of the following)
TWO (2) LETTERS FROM OFFICIALS AT CURRENT SCHOOL
(PRINCIPAL, COUNSELORS, OR INSTRUCTORS)
ONE (1) LETTER FROM YOUR COMMUNITY
(NEIGHBOR, CHURCH OFFICIALS, AND SO FORTH)
THREE (3) TEACHER EVALUATION FORMS
II. VERIFICATION OF INCOME (Must submit Income Tax Return or Other Documentation of Income)
SIGNED FEDERAL INCOME TAX RETURN
NOTE: A complete signed copy of the return must be presented with the
application – not the electronic sheet only.
OR
SOCIAL SECURITY LETTER
VA LETTER
TANF
OTHER DOCUMENTATION OF INCOME
III. HANDWRITTEN BIOGRAPHICAL ESSAY (150 WORDS OR MORE)
IV. OFFICIAL TRANSCRIPT or CUMULATIVE RECORD (copy from school counselor)
MAIL COMPLETED APPLICATION PACKETS TO:
DIRECTOR, TRiO-UPWARD BOUND PROGRAM
ALABAMA A&M UNIVERSITY
P.O. BOX 347
NORMAL, ALABAMA 35762

Personal Data
100% funded by the U.S. Department of Education
RY 2012 – Application
Alabama A&M University
Upward Bound Program
Student Application
Name of Applicant: ________________________________________________________________________
Last First Middle
Address: _________________________________________________________________________________
City: _________________________________________________ State: ______ Zip: _________________
Home Phone: ( ) _______________________ Cellular Phone: ( ) ________________________
Social Security #: ________ - _____ - _______ Date of Birth: _________________ Age: ______
Sex: Male Female Email: _________________________________________
Ethnic Status: (For reporting purposes only)
Black or African American White Asian American Indian/Alaskan Native
Hispanic or Latino Native Hawaiian or Other Pacific Islander Other ___________
Academic Needs: (check all that apply)
Lack of opportunity, support, and/or guidance to take challenging college preparation courses
Lack of confidence, self-esteem, and/or social skills
Lack of career goals and/or need for accurate information on careers
Grade Point Average below 2.5 Predominately Low-Income Community
Low Educational Aspirations Limited proficiency in English
Low Achievement Test Scores Rural Isolation
Other___________________
Have you participated in any other TRiO Program? Yes No
If yes, list the name and location of the TRiO program. ___________________________________________
Academic Data
School (Current): ____________________________________________ Grade: 8 9 10
(Please Circle One)
School Address: ___________________________________________________________________________
Street City State Zip
School Principal: _______________________________ Counselor: _______________________________
What is your current GPA?________ Do you plan to attend postsecondary school? Yes No

Family Data
Mother’s/Guardian’s Name________________________________ Social Security #:_____ - _____ - _____
Address__________________________________________________________________________________
Street City State Zip
Date of Birth _______________ Age___________ Email : ___________________________________
Employer_____________________________________ Annual Salary or Income $ __________________
Work : ( ) __________________ Home : ( ) __________________ Cell : ( ) __________________
Father’s/Guardian’s Name________________________________ Social Security #:______ - ____ - _____
Address__________________________________________________________________________________
Street City State Zip
Date of Birth______________ Age___________ Email : ___________________________________
Employer_____________________________________ Annual Salary or Income $ __________________
Work : ( ) __________________ Home : ( ) __________________ Cell : ( ) __________________
TOTAL FAMILY INCOME $ ___________________________________
With whom do you live? Father Mother Both Grandparents
Guardian Orphan/Ward of the Court Other____________________
Total number of persons in household (self included): _______
Total number of family members in household dependent on income of parent(s)/guardian(s): ________
Does your parent(s)/guardian(s), with whom you live, have a four-year (bachelors) degree? Yes No
Are you a United States Citizen? Yes No If no, are you a permanent resident? Yes No
I, ____________________________________ authorize the personnel of Alabama A&M University
(Name of Parent/Guardian)
TRiO-Upward Bound Program to secure all data needed to determine my child’s eligibility for participation
in the Program.
I understand the goals, objectives and requirements of TRiO-Upward Bound and agree to support my child in fulfilling them. I also
understand that if my son/daughter does not fulfill the required goals and objectives, he/she will be terminated from the Program. I certify
that all of the information I have provided is factual and correct to the best of my knowledge.
_______________________________________________ ________________________
Student Signature Date
_______________________________________________ ________________________
Parent/Guardian Signature Date
100% funded by the U.S. Department of Education
RY 2012 – Application