STUDENT APPLICATION

40 Education Sciences Bldg |

PREPARING FUTURE COLLEGE GRADUATES SINCE 1966

40 Education Sciences Building 56 East River Road

Minneapolis, MN 55455

Phone: (612) 625-3021 Email: ubtrio@umn.edu Website: www.cehd.umn.edu/trio/upward-bound

Facebook: www.facebook.com/upwardboundumntc

Application PRIORITY Deadline: November 15, 2019

Application REGULAR Deadline: November 27, 2019

Turn in completed application(s) to the TRIO Upward Bound mailbox in the Main Office.

What is TRIO Upward Bound, University of Minnesota? TRIO Upward Bound (TRIO UB) is a college readiness program that helps students from low to modest

income families and/or students from families whose parents have not yet completed a college degree.

TRIO Upward Bound helps students build the skills and motivation necessary to pursue and complete a college education.

Who may apply?

Enrolled in one of our target Minneapolis high schools: Edison, North, South, or Patrick Henry;

Are in the 9th or 10th grade; Have a current grade point average of 2.5 or above;

Be a first-generation college student;

Are a U.S. citizen or permanent resident of the United States; and/or

Are in an income-eligible family (students qualify for free or reduced lunch).

What about cost? Services and activities are FREE to participants and their parents/guardians.

Participants can earn a small monthly performance stipend (money).

What services do students receive from TRIO UB? We provide year-round, holistic, intensive and long

term academic and college preparation. Services include:

Academic Year Program October - May

Summer Program June - August

Weekly after school classes

Tutoring (Monday-Thursday)

Financial aid & literacy workshops

College visits & field trips

Leadership development opportunities

Educational workshops for parents/families

Scholarship opportunities

ACT preparation

5 weeks of academic classes Monday-Friday

3 weeks of living in the dorms at the University of Minnesota Twin Cities

Experimental & cultural activities

Community service opportunities

3-day Regional College Tour

5-day wilderness retreat

6-week “Bridge” program for recent TRIO UB graduates; an opportunity to earn college credit

About TRIO Upward Bound

□ Student Application o Copy of Social Security Card

o Medical Card

□ Permission to Release Information Form □ 2 Teacher Recommendation Forms

□ Parent Application □ Turn in completed application(s) to the TRIO Upward Bound mailbox in the Main Office.

October Applications Open

November Applications Due

Follow up with applied students

Family Information Meetings

December Student are selected Letters are sent home

January New Student Orientation

Program Begins

Application Checklist & Timeline

Application Checklist & Timeline

Part One: Applicant Contact Info & Demographics

First Name: ___________________________ Middle Initial: __________ Last Name: __________________________ Address: ________________________________________________________________________________________ Street Address Apartment/Building Number (if any) City: _____________________________________ State: ___________ Zip Code: _____________________ Home Phone: _____________________________________ Cell Phone: _______________________________________

Email: ___________________________________________ Sex: Male Female Other: _______________

Social Security Number: _________/__________/__________ Please attach a copy of your Social Security Card

As a federally-funded program, we must document your Social Security Number. If you have questions for concerns, please

contact TRIO Upward Bound University of Minnesota Twin Cities at 612-625-3021 or ubtrio@umn.edu.

Date of Birth: _________/__________/__________ Age: ____________

Month Day Year

Are you a U.S. Citizen? Yes No If No, what country were you born in? _________________________

Are you a Permanent Resident? Yes No

If Yes, please attach copy of your Permanent Resident card (both sides)

Ethnicity/Race: Check all that apply to you.

Native Hawaiian / Pacific Islander Bi-Racial/Multi-Race

Hispanic / Latino American Indian or Alaskan

African American / Black Asian American / Asian

Caucasian / White Other: _________________

Part Two: Family & Educational Background

What languages do you speak and/or spoken in your home?

Primary: _____________________________________ Secondary: ________________________________________ Who do you live with? Check all that apply. One parent Alone Non-relative Guardian: __________________ Both parents Spouse Relative Guardian: _____________________ Step Parent(s) Group Home Other: _______________________________ Foster Parent(s) Foster Home: Name of Parent/Guardian 1: _______________________________ Phone Number: ________________________ Name of Parent/Guardian 2: _______________________________ Phone Number: ________________________

Student Application Please use a BLUE or BLACK pen. DO NOT USE PENCIL!

What Middle School did you attend? ____________________________________ Middle School GPA: _________ What High School do you currently attend? (Circle one) Edison Patrick Henry North South High School Email: __________________________ MPS Student ID #: ___________ High School GPA: _________ Current Grade: (Circle one) 9 10 11 Name of High School Counselor: ________________________ Are you enrolled in an ESL or ELL class? Yes No If yes, please list: ________________________________________________________________________________ Do you have any disabilities (physical, mental, learning, etc.)? Yes No If yes, please list: ________________________________________________________________________________

What extra-curricular activities are you currently involved in or plan to join? Check all that apply. Sports: _______________________________________ Day(s) of the week? ___________________________

Music: _______________________________________ Day(s) of the week? ___________________________

Clubs: _______________________________________ Day(s) of the week? ___________________________

Faith/Religious: _______________________________ Day(s) of the week? ___________________________

Other: _____________________________________________________________________________________

Do you have a job? Yes No If yes, what is the name of your employer? __________________________

What days do you typically work? ______________________________ How many hours a week? ______________

How will you balance TRIO Upward Bound with your afterschool activities, work, and home life?

Have you ever been in a TRIO Upward Bound, Educational Talent Search (ETS), or GEAR UP? Yes No If yes, where and when? __________________________________________________________________________ Can you commit to participating in TRIO Upward Bound Summer Program each summer, including:

1. Five weeks of summer academic enrichment classes Monday – Friday, June and July,

2. Stay overnight in the residence halls at the University of Minnesota Twin Cities for three weeks, AND

3. Participate in college tours and service trips

Yes No

My signature verifies that all information is accurate and true to my knowledge. ______________________________________________________ _______________ Student Signature Date

Part Three: Extra-Curricular & After School Commitments

Part Four: Student Questionnaire & Essays

List two non-academic (not school related) facts you want TRIO Upward Bound staff to know about you:

1. _____________________________________________________________________________________________

_______________________________________________________________________________________________

2. _____________________________________________________________________________________________

_______________________________________________________________________________________________

Choose one word to describe yourself: ______________________________

Why did you choose that word?

_______________________________________________________________________________________________

_______________________________________________________________________________________________

If you could meet anybody, fictional or non-fictional, dead or alive, who would it be and why? _______________________________________________________________________________________________

_______________________________________________________________________________________________

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TRIO Upward Bound offers a variety of services to increase your knowledge and skills. Which of the following

interests you? Check all that apply.

□ Communicate better with my family

□ Learn to express emotions

□ Set and accomplish goals

□ Discover my strengths and weaknesses

□ Develop public speaking skills

□ Communicate my feelings

□ Learn to be less shy and/or make new friends

□ Learn how to manage stress

□ Discover possible careers

□ Learn how to make decisions

□ Develop leadership skills

□ Experience cultural and social events

□ Participate in recreational activities

□ Improve study skills

□ Improve test taking skills

□ Community service opportunities

□ Learn how to resolve conflicts

□ Learn advocacy skills

□ Other: _______________________________

How did you hear about TRIO Upward Bound? □ School Counselor or Teacher: ______________________________ □ Community Organization: _________________________________ □ Parent/Guardian or Family Member: ________________________ □ Current Student at TRIO Upward Bound: _____________________ □ TRIO Upward Bound Staff: ________________________________ □ Other: ________________________________________________

Please answer each essay question thoroughly with examples that reflect your academic and social interests and goals. Each answer should be in paragraph form.

Why do you want to join TRIO Upward Bound? How will TRIO Upward Bound help you?

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In 10 years, where do you see yourself? Why do you want to go to college? How will you get there?

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Who inspires you to achieve more in your academics and what is his/her message to you?

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PERMISSION TO RELEASE INFORMATION

Student Name (PRINT) ____________________________ Birth Date: ______________ Grade

Parent or Guardian Name (PRINT)

District: Minneapolis Public Schools Student ID #: School: E PH N S

Minneapolis Public Schools has my permission to release educational data (including transcripts, grades, test scores,

attendance records, IEP/504 plans, disciplinary action write ups, Naviance records, etc.) to the University of

Minnesota, College of Education and Human Development (CEHD), TRIO Upward Bound Program (TRIO UB). This

release is valid from the date of signature until my student graduates high school. I understand that this release may

be revoked at any time in writing.

I understand that this information will be used in determining admission to the program and in planning my

student’s academic programming once admitted to the TRIO Upward Bound program at the University of

Minnesota.

TRIO Upward Bound will use the educational data for the following reasons:

1. TRIO Upward Bound must report students’ progress to the U.S. Department of Education to demonstrate program effectiveness.

2. Upon request, TRIO Upward Bound will report students’ progress to the Minneapolis Public Schools to assist counselors and teachers to serve TRIO Upward Bound students better.

3. To connect TRIO Upward Bound students to scholarship agencies, youth leadership, employment, educational and other programs.

4. To obtain college admission and financial aid application fee waivers. 5. To discuss admission and financial aid opportunities with educational professionals. 6. Permission to participate in TRIO Upward Bound approved research projects designed to improve services and

identify areas where TRIO Upward Bound students need assistance.

We (student and parent/guardian) have read the above information and understand that this consent takes effect on

the date of signature.

Student Signature: ___________________________________ Date: _____________________

Parent/Guardian Signature: ____________________________ Date: _____________________

Students under the age of 18 must have a parent or guardian signature.

TRIO Upward Bound

University of Minnesota Twin Cities

College of Education + Human Development

40 Education Sciences Building

56 East River Road, Minneapolis, MN 55455

Office: 612-625-3021

TRIO Upward Bound

University of Minnesota Twin Cities

College of Education + Human Development

40 Education Sciences Building

56 East River Road, Minneapolis, MN 55455

Office: 612-625-3021

TEACHER RECOMMENDATION FORM #1 English, Math, or Science Class

Student Name: ________________________________________ is applying to TRIO Upward Bound (TRIO UB), College of

Education and Human Development, University of Minnesota. TRIO UB is an academic and residential 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 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 TRIO Upward Bound. We are looking for indicators

that this student has a desire to do well and will take advantage of TRIO Upward Bound services.

High School: (Circle one) Edison Patrick Henry North South

Teacher Name: ______________________________________ Course: _____________________________________

Email: ___________________________________________ Can we contact you via email if needed? Yes No

1. Does the student complete assignments on time? Yes No

How many assignments is this student currently missing: _______

2. What grade do you estimate the student to be earning at THIS time? _________

3. Please estimate: Number of days tardy: _________ Number of days absent: _________

4. Check any of the following attitude and behavior characteristics to describe this student:

5. Students’ quality of work in your class is: (Circle one)

□ Assertive

□ Hard Worker

□ Positive Attitude

□ Attentive

□ Independent Worker

□ Helpful

□ Motivated

□ Disruptive

□ Needs constant supervision

□ Constantly tardy/late

□ Distracted

□ Negative attitude

□ Talks back to teacher/peers

□ Other: __________________

□ Participates in class

□ Utilizes resources

□ Responds well to intervention

□ Works well with peers

□ Actively listens in class

□ Demonstrates leadership skills

□ Overly Social

Student is … Organized OR Disorganized

Class assignments are … Thorough OR Incomplete

Student work is … Below Standard OR Standard OR Above Standard

Student … Challenges self OR Does minimum

Other comments: ___________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Thank you! We appreciate you taking the time to fill this out. Please return form to the student OR put it in the TRIO

Upward Bound mailbox in the Main Office. Please sign below to confirm you have completed this form and recommend

this student to join TRIO Upward Bound at the University of Minnesota.

________________________________________ _______________________

Teacher Signature Date

TRIO Upward Bound

University of Minnesota Twin Cities

College of Education + Human Development

40 Education Sciences Building

56 East River Road, Minneapolis, MN 55455

Office: 612-625-3021

TEACHER RECOMMENDATION FORM #2 English, Math, or Science Class

Student Name: ________________________________________ is applying to TRIO Upward Bound (TRIO UB), College of

Education and Human Development, University of Minnesota. TRIO UB is an academic and residential 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 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 TRIO Upward Bound. We are looking for indicators

that this student has a desire to do well and will take advantage of TRIO Upward Bound services.

High School: (Circle one) Edison Patrick Henry North South

Teacher Name: ______________________________________ Course: _____________________________________

Email: ___________________________________________ Can we contact you via email if needed? Yes No

1. Does the student complete assignments on time? Yes No

How many assignments is this student currently missing: _______

2. What grade do you estimate the student to be earning at THIS time? _________

3. Please estimate: Number of days tardy: _________ Number of days absent: _________

4. Check any of the following attitude and behavior characteristics to describe this student:

5. Students’ quality of work in your class is: (Circle one)

□ Assertive

□ Hard Worker

□ Positive Attitude

□ Attentive

□ Independent Worker

□ Helpful

□ Motivated

□ Disruptive

□ Needs constant supervision

□ Constantly tardy/late

□ Distracted

□ Negative attitude

□ Talks back to teacher/peers

□ Other: __________________

□ Participates in class

□ Utilizes resources

□ Responds well to intervention

□ Works well with peers

□ Actively listens in class

□ Demonstrates leadership skills

□ Overly Social

Student is … Organized OR Disorganized

Class assignments are … Thorough OR Incomplete

Student work is … Below Standard OR Standard OR Above Standard

Student … Challenges self OR Does minimum

Other comments: ___________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Thank you! We appreciate you taking the time to fill this out. Please return form to the student OR put it in the TRIO

Upward Bound mailbox in the Main Office. Please sign below to confirm you have completed this form and recommend

this student to join TRIO Upward Bound at the University of Minnesota.

________________________________________ _______________________

Teacher Signature Date