upward bound student application - Yuba College
upward bound student application - Yuba College upward bound student application - Yuba College
Upward Bound Yuba College2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858UPWARD BOUND STUDENT APPLICATIONYuba CollegeName__________________Last Name First Name MiddleAUTOBIOGRAPHICAL ESSAY: Please write a brief autobiography. Include information about your familybackground, educational and career goals, and anything else that may be helpful in giving us a more complete pictureof you. You may use additional paper if necessary.This is to certify that all information provided is true and accurate to the best of my knowledge. Furthermore, I give UPWARD BOUND at YubaCollege my permission to receive copies of my educational records and other materials necessary for participation in the program. Furtherpermission is granted to request academic and financial aid information and records from any and all postsecondary institutions in order to trackcollege progress. I understand all of my records will be kept in confidence in accordance with the Privacy Act of 1974. If selected as a memberof the UPWARD BOUND Program at Yuba College, I agree to participate in the entire program and conduct myself in a way to bring credit tomy family, my community, my school, the UPWARD BOUND Program and myself. I will not use alcohol or other drugs and will abide by therules and regulations set forth in the UPWARD BOUND policy for the entire length of time that I am a member. I agree to attend plannedmeetings during the academic year and the summer program.____________________________________Student’s Signature_______________________________Date
Upward Bound Yuba College2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858INSTRUCTIONS TO STUDENT: Please give this form to your school counselor, teacher, principalor church leader to complete for you.UPWARD BOUND STUDENT REFERRAL/RECOMMENDATION FORMStudent Name____________________________________________FirstLastGrade__________ School __________________________________Name of Person Providing Referral:_________________________________________ Student’s GPA ____________Title/Relationship: __________________________Phone: Work # _________________Home # _________________How do you know this student? _______________________________________________________________Please state frankly your evaluation of this student’s ability to benefit from the Upward Bound program.Keep in mind that the purpose of this program is to generate the academic skills and motivation essentialfor college success. Participants should possess the ability to pursue and achieve a four-year collegedegree, but may not be able to do so without the help of Upward Bound.Please address reasons(s) why you think the student has a need for the services of the program:To improve academically (identify specific subject areas of weakness): _____________________________________________________________________________________________________________________________________To improve motivational level: _____________________________________________________________________________________________________________________________________________________________________Social/personal problems (identify specific areas such as low self-esteem, interpersonal relationships, homeimprovement, etc.): ___________________________________________________________________________________________________________________________________________________________________________________________________Please provide any additional information or comments to help us better serve this student’s needs:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Referent’s Signature Return to Student or mail to: DateUpward Bound, Yuba College2088 N. Beale RoadMarysville, CA 95901(530) 749-3858 phone(530) 749-3817 fax
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Upward Bound <strong>Yuba</strong> <strong>College</strong>2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858UPWARD BOUND STUDENT APPLICATION<strong>Yuba</strong> <strong>College</strong>Name__________________Last Name First Name MiddleAUTOBIOGRAPHICAL ESSAY: Please write a brief autobiography. Include information about your familybackground, educational and career goals, and anything else that may be helpful in giving us a more complete pictureof you. You may use additional paper if necessary.This is to certify that all information provided is true and accurate to the best of my knowledge. Furthermore, I give UPWARD BOUND at <strong>Yuba</strong><strong>College</strong> my permission to receive copies of my educational records and other materials necessary for participation in the program. Furtherpermission is granted to request academic and financial aid information and records from any and all postsecondary institutions in order to trackcollege progress. I understand all of my records will be kept in confidence in accordance with the Privacy Act of 1974. If selected as a memberof the UPWARD BOUND Program at <strong>Yuba</strong> <strong>College</strong>, I agree to participate in the entire program and conduct myself in a way to bring credit tomy family, my community, my school, the UPWARD BOUND Program and myself. I will not use alcohol or other drugs and will abide by therules and regulations set forth in the UPWARD BOUND policy for the entire length of time that I am a member. I agree to attend plannedmeetings during the academic year and the summer program.____________________________________Student’s Signature_______________________________Date
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