St. Olaf College TRIO Upward Bound Parent Application

Dear Parent/Guardian(s):

Before completing the attached application, please take time to read and understand the information in this letter. The material below will help you determine if you and your student wish to apply to participate in the St. Olaf Upward Bound program.

The major goal of the Upward Bound program is to help students develop the skills and motivation required to succeed in education both in high school and beyond. Admission to the Upward Bound program is not automatic; students must successfully complete a rigorous application and selection process. To qualify for Upward Bound, students must be either from low-income families or be potential first-generation college students (neither parent/guardian has a 4-year degree).

Upward Bound (UB) is a federally funded TRIO program designed to assist students who are interested in enhancing their academic skills and furthering their education. St. Olaf College UB students are recruited from five St. Paul high schools: Central High School, Creative Arts Secondary School, Highland Park High School, Humboldt High School and Open World Learning Community. Admitted students must take all activities required by the program seriously. If UB does not feel the student is making the necessary commitment to his/her education, the student may be placed on a performance contract, which if not fulfilled, may result in dismissal from the program.

Students who are admitted must agree to take part in UB’s intensive six-week residential Summer Program and participate in our Academic School Year Program, which have the following major objectives:

1. Increase academic performance of program participants.

2. Increase the motivation of program participants to succeed in high school and attend college.

3. Provide informative and enriching mentoring/career/educational opportunities for all participants.

4. Increase participation in cultural/educational experiences beyond those available at their high schools.

5. Provide group/individualized tutoring, guidance and counseling for program participants.

6. Provide assistance in securing admission to a postsecondary institution and adequate financial aid to attend.

7. Provide a bridge between high school and college during the summer after the participant’s senior year.

These objectives can only be met if students actively participate and accept responsibility for participation. Please feel free to contact me if you need further information or assistance.

Sincerely,

Mari Avaloz

Upward Bound Director

 

Please note: you must complete the entire student application in one sitting within 10-15 minutes. You will not be able to save your progress to return.

This information is strictly confidential. Financial and other personal information you provide to the St. Olaf Upward Bound program is protected by the General Education Provision Act (Privacy Rights of Parents and Students/Buckley Amendment). Upward Bound and the U.S. Department of Education may not release any information without your written consent. Upward Bound is funded by the United States Department of Education and St. Olaf College. St. Olaf College Upward Bound is an equal opportunity employer and educator.

PART ONE: GENERAL INFORMATION
Student's Legal First Name *
Student's Legal Last Name *
Date of Birth *
Student's School *
Parent/Guardian #1 Name *
Parent/Guardian #1 Relationship to Student *
Parent/Guardian #1 Address *
Parent/Guardian #1 City *
Parent/Guardian #1 State *
Parent/Guardian #1 Zip Code *
Parent/Guardian #1 Preferred Phone:
Preferred Phone Type:
Parent/Guardian #1 Secondary Phone
Parent/Guardian #1 Employer
Parent/Guardian #1 Occupation
Parent/Guardian #1 Email Address
Parent/Guardian #2 Name
Parent/Guardian #2 Relationship to Student
Parent/Guardian #2 Address
Parent/Guardian #2 City
Parent/Guardian #2 State
Parent/Guardian #2 Zip Code
Parent/Guardian #2 Preferred Phone
Preferred Phone Type
Parent/Guardian #2 Secondary Phone
Parent/Guardian #2 Employer
Parent/Guardian #2 Occupation
Parent/Guardian #2 Email Address

 

The student lives with (check ALL that apply):
Mother
Father
Step Mother
Step Father
Foster Parent(s)
Alone
Spouse
Group Home
Foster Home
Guardian (not a relative)
Specify:
Relative other than parent or Other (not a relative)
Specify:
What languages are primarily spoken at home?
English Only
English AND
Other (specify):

 List in order language(s) your student speaks fluently
First Language Learned:
Second Language Learned:
Third Language Learned:

 

 If student's legal guardian is other than a natural parent, please fill out the following:
Guardian's Name
Address
City
State
Zip
Preferred Phone
Secondary Phone
Employer
Occupation
Explain (relationship to student applicant):

PART TWO: INCOME AND EDUCATIONAL INFORMATION

The U.S. Department of Education requires that Upward Bound participants meet certain eligibility guidelines (e.g., income, education, etc.). Before we can determine the student's income eligibility, we need the following information as well as documentation verifying your family's income. Please read carefully and complete all blanks.  If all information is not completed, this form cannot be processed.

 
1. Are you the legal parent/guardian of the student? *
2. Is the student listed above a U.S. Citizen? *
*If student is accepted into UB, we will require their Social Security number.
3. Is the student listed above a Permanent U.S. Resident? *
*If yes and accepted, a copy of their card will be required for their UB file.

4. List all other individuals that live in this student's household? (Upload additional sheets if necessary)

Also, please indicate U.S. Citizenship/Permanent Resident status of each family member listed.
Household Member 1 Name
Household Member 1 Relationship to Student
Household Member 1 Age
Household Member 1 U.S. Citizenship
Household Member 1 Permanent Resident
Household Member 2 Name
Household Member 2 Relationship to Student
Household Member 2 Age
Household Member 2 U.S. Citizenship
Household Member 2 Permanent Resident
Household Member 3 Name
Household Member 3 Relationship to Student
Household Member 3 Age
Household Member 3 U.S. Citizenship
Household Member 3 Permanent Resident
Household Member 4 Name
Household Member Relationship to Student
Household Member 4 Age
Household Member 4 U.S. Citizenship
Household Member 4 Permanent Resident
Household Member 5 Name
Household Member 5 Relationship to Student
Household Member 5 Age
Household Member 5 U.S. Citizenship
Household Member 5 Permanent Resident
Household Member 6 Name
Household Member 6 Relationship to Student
Household Member 6 Age
Household Member 6 U.S. Citizenship
Household Member 6 Permanent Resident
*If you have more people in your household, please upload a document for the rest of the members and their information.
5. Did you file a federal income tax return for last year (2023)? *
6. What is the source of family income? (Check all that apply)
Fathers employment
Occupation and monthly gross amount
Mothers employment
Occupation and monthly gross amount
Guardian 1 employment
Occupation and monthly gross amount
Guardian 2 employment
Occupation and monthly gross amount
Social Security
Rate per month
Other
Specify

*If you receive TANF (temporary assistant for needy families) or other public assistance, please upload a copy of your document.

If over income: If the student's family income exceeds the above amounts, their application will still be considered if neither parent/guardian has completed a 4-year (baccalaureate) degree.

Additional questions: Please contact Nou Yang, Upward Bound Associate Director, St. Olaf College, 507-786-3707 or 651-785-6281.
*Please upload a copy of your 2023 Federal Income Tax Forms (1040 or 1040-SR):

 

7. Select the highest level of education completed:
Father
Mother
Step-Parent
Guardian 1
Guardian 2

 

8. Check all statements that apply:
I attend school programs and/or teacher conferences.
I check my child's school/homework.
I encourage my child to continue education after high school.

 

9. Do you support your student's interest in participating in the St. Olaf College Upward Bound program? Please explain.

 

PART THREE: AGREEMENTS
If admitted to the program, each student agrees to:

1. Complete minimum course requirements each school year to be on track for graduation.

2. Attend the Upward Bound six-week, summer academic camp each summer and complete the assigned work.

3. Abide by St. Olaf College Upward Bound dorm and campus rules.

4. Participate in the Upward Bound Bridge Program during the senior year and the summer following high graduation.

5. Remain in contact with Upward Bound during the school year.

  a. Regularly meet with Upward Bound Staff during school visits.

  b. Attend schedule Upward Bound Meetings.

  c. Notify Upward Bound of changes in address and phone number.

6. Participate in the UB Alumni Mentor Program.

7. Complete any other requirements as requested by the Director of Upward Bound.

8. Plan to enroll in postsecondary education for the Fall semester immediately following high school graduation.

 

I understand the goals, objectives, and requirements of the St. Olaf Upward Bound program and agree to support my child in fulfilling them. I also understand that if my child does not meet the required goals and objectives, they will be terminated from the program. I further certify that all financial and educational information on this form is valid and correct.
*
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PART FOUR: RELEASES

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize the St. Olaf College Upward Bound Program to provide information on behalf of my child to the schools and/or agencies indicated below:       

1. Minnesota Education Equity Partnership

2. Postsecondary Institutions (universities/colleges, technical schools, etc.)

3. Student applicant's current and/or former junior or senior high school

I also authorize St. Olaf College Upward Bound to provide information on behalf of my child to a non-custodial parent(s)/guardian(s).*

*St. Olaf College Upward Bound will follow the official policy on school records, information and confidentiality established by your child’s school district, unless otherwise noted.

I understand that the policy of the St. Olaf College Upward Bound program is to release only that information about a student or former student that, in judgment of the staff, is considered essential.
*
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AUTHORIZATION FOR RELEASE OF RECORDS

I hereby authorize the Saint Paul Public School District to release complete school transcripts (including attendance, dean's reports, official quarterly and final grade reports, standardized test scores and IEPs) of my child to the St. Olaf College Upward Bound Program. I understand that this information will be kept confidential unless otherwise authorized.
*
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Date: *