Application Due April 14th, 2017
Application Due: Friday, April 14, 2017
Student Application
2400 Tom L. Wilson Blvd.
Galesburg, IL. 61401
(309)341-5268
[email protected]
Find Us At:
http://www.sandburg.edu/academics/upward-bound
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
INFORMATION ABOUT TRIO UPWARD BOUND
1.
What is TRIO Upward Bound?
A. TRIO Upward Bound (UB) is a college readiness program designed to assist high school students from low to modest
income families and/or from families whose parents have not yet completed a four-year college degree
B. TRIO Upward Bound assists high ability students to successfully develop the skills and motivation necessary to pursue
and complete a college education.
2. Who may apply?
Students may apply if they are in 8th, 9th or 10th grade and attend one of our target schools (Abingdon-Avon, Galesburg, Knoxville, ROWVA). Applicants must be:
A. A U.S. citizen or permanent resident of the United States;
B. A potential first-generation college student (parents have not earned a four year college degree); AND/OR
C. Is considered income-eligible based on family’s taxable income for 2016.
Eligible students may also;
A. Have a high risk for academic failure.
3. How much does it cost?
A. All services and activities are provided FREE to participants and their parents/guardians.
4. What benefits does a student receive from participating in TRIO Upward Bound?
A. TRIO UB offers academic year services of tutoring, workshops, and college access advising designed to enhance student
academic skills and achievement. Upward Bound also offers weekly grade-specific academic sessions:
*SENIORS: Weekly meetings with UB counselor, college visits, help with college applications and essays,
scholarship applications, and financial aid assistance.
*JUNIORS: Weekly meetings with UB counselor, study skills, college visits, SAT prep workshops, SAT waivers,
informative financial aid workshops, career and college exploration
*SOPHOMORES: Weekly meetings with UB counselor, study skills, college visits, financial aid informational
meetings, career and college exploration
*FRESHMAN: Weekly meetings with UB counselor, study skills, college visits, cultural activities
B. TRIO UB offers 6 weeks of academic summer services. During this program students engage in:
* Skill improvement in English, math, science, foreign language, and more.
* Cultural, social, and recreational activities designed to foster personal growth, build leadership skills, and
broaden student awareness and appreciation of the world.
C. TRIO UB offers extra enrichment activities during the summer for specific grade levels:
* Graduating Seniors are given the opportunity to complete up to two college courses for credit (Summer Bridge)
* Rising seniors have the opportunity to complete a paid summer internship in a career field of their choice
* Rising Juniors and Sophomores participate in the 6 week program focusing on English, math, science , and
foreign language.
* All summer participants have the opportunity to attend a week long Summer Trip.
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
THE COMPLETE APPLICATION PROCESS
Step 1: Submit a student application. (If you are reading this...you have one!) TRIO Upward Bound recruits
students from Abingdon-Avon, Galesburg, Knoxville and ROWVA area schools. The recruiting season is from
February through April 14, 2017. TRIO UB provides applications during information sessions held in the
schools.
Step 2: Parents must submit an Eligibility form and return it as part of the Student Application.
Step 3: Students and Parents must call and schedule an interview with TRIO UB staff to discuss their application and goals, as well as Upward Bound benefits, expectations and requirements.
Step 4: Students must take the Stanford 10 online exam during one of our scheduled testing dates
Step 5: Students and parent(s) are notified of admission decision. Upward Bound makes admission decisions in May. Newly admitted students begin TRIO UB participation in September.
Step 6: New Student Orientation. If students are notified that they are accepted into our program, parent(s)
and student meet with staff to discuss responsibilities and to complete new student paperwork. The orientation will be scheduled for a date in August.
STUDENT APPLICATION CHECKLIST
To make sure your student application is complete, check below to ensure you have all of the required components:
____ Student Application and Eligibility form
____ An essay titled “Why I Want to Join TRIO Upward Bound.” See the rest of this application for instructions on how to
write this essay.
____ Permission to Release Information form, signed by student and parent/guardian. See the rest of this application
packet to find this form.
____ One teacher recommendation from either your Science, English or Math teacher. These can be returned by the stu
dent with this application (in a sealed envelope) OR the teachers may mail them directly to the UB offices. See the
rest of this application packet to find these recommendations.
____ Please also enclose the student’s most recent report card or copy of transcripts, copy of parents 2016 Income Tax
Return and a copy of the student’s most recent PARCC scores.
____The Stanford 10 online exam will be offered on the following dates: March 23th, and 30th at 5:30 p.m.; April 6th
and 13th at 5:30 p.m. and April 8th at 10:30 a.m. All exams will be administered in Building B, room B26 on the
Carl Sandburg College Main Campus in Galesburg. Please view the enclosed map for reference.
APPLICATION DUE DATE APRIL 14, 2017
* Return all of these materials to the Upward Bound office, located at Carl Sandburg College. Mailed applications may be sent to
the following address: Carl Sandburg College Upward Bound, 2400 Tom L. Wilson Blvd., Galesburg, IL. 61401. If you have any questions, please contact Sara Gross at 309-341-5268 or via email, [email protected].*
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Personal Information
Please Print Clearly
Name __________________________________________________
First
Middle
School______________________
Grade______
Last
Cell Phone________________
Address ________________________________________________
________________________________________________
Home Phone______________
Birthday____/______/________
Email address____________________________________________
Gender: Male_____
Female____
Need for Program Services
Please check the services you are most interested in receiving from Carl Sandburg College Upward Bound Program:
_____ Academic Tutoring
_____ College Field Trips
_____ ACT Prep
_____ College Prep
_____ Personal Counseling
_____ College Admissions
Assistance
_____ Career Awareness
_____ Peer or Professional
Mentoring
_____ Educational Planning
_____Financial Assistance
_____ Cultural Field Trips
Family Information
With whom do you live? Both Parents____
One Parent____
Legal Guardian____
Foster Family____
Other (please explain)_______________________________________________________________________
Mother’s Name ____________________________
Daytime Phone No._________________________
Father’s Name ____________________________
Daytime Phone No._________________________
Guardian’s Name ___________________________
Daytime Phone No._________________________
Please list your brothers and/or sisters with their ages and current grade level:
Name
Age
Grade
Name
Age
Grade
________________
___
____
________________
___
____
________________
___
____
________________
___
____
________________
___
____
________________
___
____
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Page 2
Academic Ability
Please list your classes and the grade you received on your most recent report card
1._________________________
_______
5._______________________
_____
2._________________________
_______
6._______________________
_____
3._________________________
_______
7._______________________
_____
4._________________________
_______
8._______________________
_____
Future Educational Plans
Upward Bound is designed to help students achieve academically in school and enter postsecondary education. Please check the
statement below that best describe your educational plans.
____ I am undecided about my educational goals.
____ I have no plans to continue my education after high school graduation.
____ I plan to enter the military.
____ I plan to attend a state supported college or university.
____ I plan to attend a college or university out of state.
____I plan to attend a private school in Illinois
Please list two career fields of interest
1._________________________________
2.________________________________
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education
to raise college entrance and graduation rates in Knox County. This is a year-round educational experience. Upward Bound students are required to attend scheduled weekly workshops, participate in program travel, attend after-school tutoring and participate in the six-week summer program held on the Carl Sandburg College campus.
My signature below indicates, to the best of my knowledge, the information provided on this form is true, complete and accurate.
I hereby authorize the Carl Sandburg College staff to obtain copies of my child’s academic and financial assistance records from the
educational institution he or she is now attending and from educational institutions attended in the future.
____________________________________
___________
_________________________________
________
Student’s Signature
Date
Parent/Guardian Signature
Date
For Office Use Only
Application________
Interview________
App Forms______
Test______
Accepted______ Letter______
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Eligibility Form
Student Information
(Please print clearly)
Name____________________________________
First
MI
School________________
Grade______
Last
U.S. Citizen: ____Yes
____No
Ethnicity: (Mark all that applies)
White___ African American___ Hispanic____ American Indian____
Hawaiian/Pacific Islander____
Parents’ Educational Completion
Mother/Guardian Name:____________________
Father/Guardian Name:___________________
Please circle highest educational level completed
Please circle highest educational level completed
Grades 1-8
Grades 1-8
9
10
11
12
Certificate Program
2– Year Associate
9
10
11
12
Certificate Program
4– Year Bachelor
2-Year Associate
4-Year Bachelor
Income Documentation
How many people live in your household (include children away at school)___________
Please enter your taxable income from
If you filed Form 1040 use Line 43: $_________
Your 2016 income tax form.
If you filed Form 1040A use Line 27: $__________
Do not use Adjusted Gross Income for this report.
If you filed Form 1040EZ use Line 6: $__________
If you did not file an income tax form, please indicate the amount shown on 2016 End of Year Statement:
Wages, Salaries or Tips:
$______________
Business or Farm Income:
$______________
Social Security Benefits:
$______________
Veteran’s Benefits:
$______________
Unemployment:
$______________
My signature below indicates, to the best of my knowledge, the information provided on this form is true, complete and accurate.
I hereby authorize the Carl Sandburg College staff to obtain copies of my child’s academic and financial assistance records from the
educational institution he or she is now attending and from educational institutions attended in the future.
Parent or Guardian’s Signature:________________________________________
Date:_____________________
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Upward Bound Essay: “ Why I Want To Join Upward Bound”
Essay Instructions
You must complete an essay as part of your application. This essay is your opportunity to explain:
1.) How TRIO Upward Bound will be helpful to you
2.) What you as a person will contribute to the program
Please be specific. Your essay will be evaluated for content, organization, creativity, and attention to detail.
You should also answer the following questions as you write:
Why are you interested in TRIO Upward Bound, and what makes you a good fit?
What obstacles may prevent you from getting into college? How can you overcome it?
What are some of your ACADEMIC weaknesses?
What are you doing to strengthen your skills in these areas?
How would you balance Upward Bound with other activities you may be involved in such as sports,
work, church and family?
Who inspires you to achieve your academics?
We ask that you please type your essay (you may attach a page printed from a computer word document) or
write (print clearly in blue or black ink) using the designated space below and on the next page. Use additional paper if needed.
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The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Essay continued
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The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
TRIO Upward Bound
Carl Sandburg College
Teacher Recommendation-English, Math or Science
Dear Teacher,
Student Name:______________________ is applying to the Carl Sandburg College TRIO Upward Bound program. TRIO Upward
Bound is a college preparatory program for students who come from low-income families and/or are the first generation in their
family to attend college. We provide students with intensive academic skill building and intensive college planning activities. Feedback on this student’s performance and attitude in your class will help us to evaluate his/her potential to be successful in the Upward Bound program. We are looking for indicators that this student has a desire to do well and will take advantage of the TRIO
Upward Bound services offered. Please mail to Upward Bound 2400 Tom L. Wilson Blvd. Galesburg, IL. 61401 or fax to 345.3527
Course:________________
School:__________________
1) Does the student complete assignments?
Yes____
Teacher Name:_________________
No_____
2) What grade do you estimate the student is earning at THIS time? __________
3) Estimate: a) Number of days absent:________; b) Number of days tardy:_______
Teacher Questionnaire
1. In your opinion, how well has the student considered and prepared for a pre-college program, such
as Upward Bound?
________________________________________________________________________________
________________________________________________________________________________
2. What do you consider the student’s most outstanding academic strength?
________________________________________________________________________________
________________________________________________________________________________
3. What areas do you feel Upward Bound could assist this student academically?
________________________________________________________________________________
________________________________________________________________________________
____Motivation
____Goal Oriented
____Basic Skills (Math, Reading)
____Commitment
____Leadership/Social Skills
____Career Goals
____Other ___________________________________
Signature:___________________________________
Date:__________
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Parent Questionnaire
Applicant:____________________________________
School:________________________
Parent/Guardian’s Name:________________________________________
How did you learn about Upward Bound?
If you had to choose things that your child needs to work on
either academically, socially or emotionally what would you
choose? In each area listed, identify a need that UB can help
improve on.
How would you describe your child?
If students drop below a B in a core course they are required to
attend study lab 4 hours a week until the next quarter grades
come out. Your child tells you he or she doesn’t need to go or
doesn’t want to go. How do you feel about that?
What do you want to see your child accomplish in his or her
life?
What expectations do you have on Upward Bound regarding
your child?
Why do you want your child to be in Upward Bound?
How much support can the program expect from you in regards to your stent’s involvement in Upward Bound?
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
2400 Tom L. Wilson Blvd
Galesburg, IL. 61401
Office: 309-341-5268
Fax : 309-345-3527
PERMISSION TO RELEASE INFORMATION
Student Name (PRINT): _______________________________________________
Grade:___________________
Parent or Guardians Name (PRINT):______________________________________________________
Current School:_________________________
High School attending or will be attending:________________________
Student and parent signatures on this form thereby gives the administrator(s), counselor(s), faculty or staff member(s) of the Jr.
High School and High School of attendance of the below signed student permission to release current grades and/or test scores to
representatives of the Upward Bound program of which the below signed student has applied. This release will be kept on file in
the Upward Bound offices.
Name of Jr. High School:__________________________________
Name of High School:_____________________________________
Student’s Printed Name:_________________________________
Student’s Signature:_____________________________________
Date:___________________
Parent’s Printed Name:_____________________________
Parent’s Signature:_________________________________
Date:_______________
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
The College, an equal opportunity/affirmative action employer and educator, complies with applicable federal and state laws prohibiting discrimination, including Title VI, Title IX, Section 504, Age Discrimination Act,
and Title II of the ADA. It is the policy of the College that no person, on the basis of race, color, religion, gender (sex), sexual orientation, national origin, age, disability, or veteran’s status, or status in any group protected by application federal, state or local law shall be discriminated against in employment, in educational
programs and activities, or in admissions. Title IX Coordinator Rick Eddy, 309.341.5234; ADA/Section 504 Coordinators: Rodney Blue, 309.341.5250; Jacob Runge, 309.341.5262.
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Please Keep this sheet to write down your interview date and time
Step 1: Submit a student application. TRIO Upward Bound recruits students from Abingdon-Avon, Galesburg, Knoxville and ROWVA area schools. The recruiting season is from February to April 14, 2017. TRIO UB
provides applications during information sessions held in the schools.
Step 2: Parents must submit an Eligibility form and return it as part of the Student Application.
Step 3: Students and Parents must call and schedule an interview with TRIO UB staff to discuss their application and goals, as well as Upward Bound benefits, expectations and requirements. The interview must
be done prior to the April 14th deadline.
Step 4: Students must take the Stanford 10 exam during one of our scheduled testing dates. Testing must
be done prior to the April 14th deadline.
Step 5: Students and parent(s) are notified of admission decision. Upward Bound makes admission decisions in May. Newly admitted students begin TRIO UB participation in September.
Step 6: New Student Orientation. If students are notified that they are accepted into our program, parent
(s) and student meet with staff to discuss responsibilities and to complete new student paperwork. The orientation will be scheduled for a date in August.
Interview
You will need to set up an interview with a staff member of the Upward Bound program as soon as you
submit your application. Please call Sara Gross at 309.341.5268 or email at [email protected]
Date of Interview:__________________
Time of Interview:__________________
Name of the Person doing the interview:_________________________
Location of Interview: Building E, Student Success Center, Room # E-136
Stanford 10 Online Exam Dates
All Upward Bound applicants must complete the Stanford 10 online exam. All exams will be given on the Carl
Sandburg Main Campus in Galesburg (please view map on next page) in Building B, room # B26. Please
choose one date to complete the test.
March 23rd and 30th at 5:30 p.m.
April 8th at 10:30 a.m.
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
Carl Sandburg College Main Campus, Galesburg
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.
Application Due April 14th, 2017
The Carl Sandburg College Upward Bound program is 100% funded in the amount of $270,375 by the US Department of Education.