The University of Memphis Upward Bound Program is a federally funded program whose purpose is to provide its students the skills necessary to complete high school and obtain a college degree, upon graduating from high school. Students who apply for the program must plan to attend college, have academic potential, need assistance with college preparation, and be willing to put forth the effort to excel academically.Please make note that we will not consider incomplete applications.

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

• Must be a U.S. Citizen or a Permanent Resident of the United States.
• Must be a low-income individual and/or a potential first-generation college student.
• Must be enrolled at a program target school: Sheffield, Melrose, or Kirby High School.

Personal information should be provided by a parent or guardian. Students are selected for Upward Bound 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 online application completely by including ALL requested information on each form.
• Check the SIGNATURE boxes and provide FULL DATES in designated areas.
• Submit this 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 (8am-4pm).***

Email: upwardbound@memphis.edu
Phone: 901.678.1482 or 901.678.1465

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

PARENT INFORMATION / FIRST GENERATION VERIFICATION

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

In order for us to determine eligibility for participation in TRIO Upward Bound, federal regulations require us to obtain documentation of taxable income for the preceding CALENDAR YEAR.

A copy of a RECENT INCOME TAX RETURN will be REQUIRED AFTER ACCEPTANCE.

If you did not file a tax return, please complete the following:

EMERGENCY CONTACT INFORMATION

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

Please list any medical conditions we should be aware of to better serve the applicant. List any medications, allergies, food allergies/dietary restrictions or any disability that requires accommodations.

APPLICANT AGREEMENT

1. I hereby apply for admission to the University of Memphis Upward Bound program. I understand Upward Bound in an academic program designed to help students develop the knowledge and skills necessary for the pursuit of education beyond high school. I understand, if admitted, I will be expected to participate fully in the academic year program activities.
2. I agree to abide by all Upward Bound policies and rules as established to create a safe, welcoming, and positive learning environment.
3. I understand that all Upward Bound 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 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 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.