upward bound student application - Yuba College

Upward Bound Yuba College2088 N. Beale Road, TRiO/Cal-SOAP Office, Marysville, CA 95901 (530) 749-3858UPWARD BOUND ELIGIBILITY FORMStudent Name____________________________________________FirstLastGrade__________ School __________________________________Please answer both the Student and Parent/Guardian sections COMPLETELY.Street Address ___________________________________________ CityZip_________________Mailing Address (if different)_______________________________City______________________ Zip_________________Home phone______________________ E-mail address _________________________Cell Phone______________________U.S. Citizen? Yes NoSocial Security #_______________________US Resident Yes No If yes, please provide a copy of your residency card .Ethnicity_________________________Sex: Male Female Counselor______________________________ GPA _____________Birthdate _____________Career Goal _____________________________________ Do you plan to go to college? Yes No WHERE? 2-year College 4-year College Vocational/Technical Military Not sure right nowPARENT INFORMATION: (To be completed on the parent or guardian of applicant)Name __________________________________________Relationship ________________________ Occupation ___________Name __________________________________________Relationship ________________________ Occupation ___________Number of family members living at home: Adults _________ Children ____________ Total _______________________**ALL INFORMATION WILL BE HELD IN STRICT CONFIDENCE**If you filed an income tax return, please provide taxableincome from the Prior Year. See Income Tax Forms asfollows: Line 27-1040A; Line 43-1040; or Line 6-1040 EZTaxable Income* ___________________________________Year of Return _____________________________________*To verify this information and meet the U.S. Department ofEducation Requirements, we must have a copy of yourmost recent Federal Tax Return.$ 0 - $16,335$16,336 - $22,065$22,066 - $27,795$27,796 - $33,525$33,526 - $39,255$39,256 - $44,985$44,986 - $50,715$50,716 - $56,445$56,446 - AboveIf you did not file an income tax return last year, please complete thefollowing information for the most recent year.**Wages $_______________ SSA/SSI $_________________VA/GI Bill $ ___________ Unemployment $____________Pension/Retirement _________________________________Food Stamps $ ____________________________________Other (specify) ____________________________________**To verify this information and meet the U.S. Department ofEducation requirements, we need a statement from a caseworkeror a copy of a document confirming this information.