Dear Applicant,

The University of Memphis Upward Bound “Will UB My Mentor” Program is an extension of the TRiO Upward Bound program, which is a federally funded program whose purpose is to provide its students the avenues to navigate throughout the program successfully, build strong positive relationships, leadership skills, and equip fellow students with the tools necessary for success as well .Please make note of the following information below, as we will not be able to consider incomplete applications.

To be eligible to participate in the program, applicants must meet the following eligibility criteria:

• Must be an active TRiO Upward Bound participant.
• Must have a 3.0 GPA or higher.
• Must be enrolled at a program target school: Sheffield, Melrose, or Kirby High School(s).

Personal information should be provided by a parent or guardian.  Students are selected for Upward Bound Will UB My Mentor Program based collectively on recommendations from teachers or counselors, thoughtfulness of personal statements, staff observations from interviews, eligibility, and application completion. Therefore, please begin your process by doing the following:

• Fill out this application completely by including ALL requested information on the form.
• Provide INITIALS and FULL DATES in designated areas.
• Submit the application by appropriate deadline.

***If you have any questions or difficulty filling out this application please contact Upward Bound staff. For phone calls, please contact the office during regular business hours (8 am - 4 pm).***

Email: upwardbound@memphis.edu
Phone: 901.678.1413 or 901.678.1482

PRIVACY ACT AND CONFIDENTIALITY STATEMENT

The personal information you give to the Upward Bound staff is compiled and reported to the United States Department of Education. The information is protected by the Family Educational Rights and Privacy Act of 1974. No one may see the information unless they work with or for the Upward Bound Program or are specifically authorized to see the information. The information is necessary to help determine if your child is eligible to participate in the program in which the goal is to assist students in obtaining a post-secondary education. The Department of Education has the authority to gather information to help make Upward Bound a better program for future participants. (20 United States Code 12 3/A). Great care is taken to make sure that the personal information collected on students is kept confidential. Any student who wishes to be considered for membership in the University of Memphis Upward Bound Program and receive its benefits must agree to submit all necessary information requested by Project personnel.

STUDENT INFORMATION

EDUCATION INFORMATION

PERSONAL STATEMENTS

EMERGENCY CONTACT INFORMATION

Parent Information: (completed by parent or guardian with whom applicant lives)
ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE

Name of person(s) to be contacted if parent(s) is not available in the event of an emergency

APPLICANT AGREEMENT

1. I hereby apply for admission to the University of Memphis Upward Bound Will UB My Mentor program. I understand Upward Bound Will UB My Mentor Program is in an extension of the TRiO Upward Bound academic program designed to help students develop the knowledge and skills necessary for the pursuit of education while still enrolled and beyond high school. I understand, if selected, I will be expected to participate fully in the Will UB My Mentor Program activities.
2. I agree to abide by all Upward Bound Will UB My Mentor Program policies and rules as established to create a safe, welcoming, and positive learning environment.
3. I understand that all Upward Bound Will UB My Mentor Program participants, regardless of age, may not possess, use, or distribute to others tobacco products, alcohol, or illegal drugs. I understand that if I violate this policy, I will be subject to suspension or expulsion from the program.
4. I hereby certify that all the information provided in this application packet is true and correct. I understand that a false statement or misrepresentation will make the applicant ineligible for the University of Memphis Upward Bound Will UB My Mentor Program.

PARENT AGREEMENT

I have read and agree to the above provisions to which my child has agreed. I give permission for my child to participate in the Upward Bound Will UB My Mentor Program and I acknowledge that University of Memphis cannot guarantee the health, safety, or well-being of any individual. I understand that admission to and continuation in the program is at the discretion of the coordinator upon review of my child’s academic standing, level of participation, attitude, behavior, or upon the coordinator’s assessment of the program’s capacity to adequately meet the specific needs of my child.