EmailMe Form - UPWARD BOUND PROGRAM APPLICATION

Applicant's Name *
First Last
Date of Birth: *
MM / DD / YYYY
Gender
Male
Female
Age:
Social Security Number: *
Race/Ethnicity:
American Indian/Alaskan Native
Asian
Black/African American
White
Hispanic/Latino
Native Hawaiian/Other Pacific Islander
Two or more races
Other
Mailing Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Home Phone *
### - ### - ####
Emergency Phone:
### - ### - ####
Cell:
### - ### - ####
Grade in School:
Name of School:
My Child receives:
Student's Email Address:
Parent's Email Address:
Curriculum or Tract:
College Preparatory/Technical Dual
Technical
College Preparatory
Does the child plan to pursue Post-Secondary education?
Yes
No
For Eligibility purposes: Are you an American Citizen? *
Yes
No
PART TWO: FAMILY SIZE AND FINANCIAL/INCOME INFORMATION
The following is strictly confidential and will not be seen by anyone, with the exception of Abraham Baldwin College Upward Bound Staff.
PARENTS: Please refer to your 2019 Taxable Income which can be found on line 11b on your tax returns. Input the amount below. Please note that a copy of your tax returns will be required later for verification. *
PART THREE: FIRST-GENERATION DOCUMENTATION: Check the appropriate response: *

Yes NO

Mother has a four year degree:

Father has four year degree:
PART FOUR: PARTICIPATION AGREEMENT AND CONTRACT
I give permission for my child to participate in the Upward Bound Program of Abraham Baldwin Agricultural College. It is my understanding that Upward Bound is divided into two components: A summer component and an academic component.
School Year Program:
I grant authorization to allow my child to participate in all afterschool tutorial programs, workshops, seminars, Saturday class sessions, surveys, field trips and other program activities throughout his/hers participation with the Upward Bound Program at the Abraham Baldwin Agricultural College.
Summer Residential Program:
I grant authorization to allow my child to participate in the summer residential program. I grant permission for my child to live in the residential facility for weeks, take classes 5 days per week, participate in social, cultural and recreational activities, Summer Olympic activities, educational field trips, and other program activities throughout his/her participation with the Upward Bound Program at Abraham Baldwin Agricultural College.
NOTE:
The information requested in this application is necessary and will be treated in a confidential manner. All items must be completed to be considered for entrance into the program.

	Yes	NO
Mother has a four year degree:
Father has four year degree:

PART TWO: FAMILY SIZE AND FINANCIAL/INCOME INFORMATION

PART FOUR: PARTICIPATION AGREEMENT AND CONTRACT

School Year Program:

Summer Residential Program:

NOTE: