ADMISSION APPLICATION VINCENNES UNIVERSITY UPWARD BOUND

VINCENNES UNIVERSITY UPWARD BOUND VERIFICATION AND TRANSCRIPT RELEASE FORM

I declare that the information I have provided in this application is true and correct to the best of my knowledge. I understand I will need to furnish income verification with a signed statement or a current federal tax return if my child is selected to participate in Upward Bound. I hereby give my permission for the release of high school and college records including but not limited to grades, attendance records, standardized test scores and financial aid records to the staff of Vincennes University Upward Bound from date of application through six years after high school graduation to include graduation from a post-secondary institution.
(Step)Father/Guardian's Signature
Date of Application

MonthDayYear
Date
(Step)Mother/Guardian's Signature
Applicant's Signature
Year of Applicant's High School Graduation

MonthDayYear
Date
I hereby give my consent for my son/daughterblanks to participate in the Vincennes University Upward Bound. I understand Upward Bound is in operation during the school year and for six weeks in the summer. As parent/guardian I give my permission for my child to participate in any field trips or activities which are sponsored and supervised by Vincennes University Upward Bound staff during both the summer and the academic year.
Parent/Guardian's Signature
A COPY OF THIS SHEET IS AS VALID AS THE ORIGINAL

Attention: The personal information given to Upward Bound is used to create the Annual Performance Report that is required by the U.S. Department of Education. The legislative and regulatory authorities to collect this information are:
- Title IV, Part A, Subpart 2, Chapter 1, Section 402A9c(2) and Section 402C, of the Higher Education Act of 1965, as amended;
- The program regulations in 34 CFR Part 645; and
- Sections 75.590 and 75.720 of the Education Department General Administrative Regulations.
Upward Bound is a federal grant program that serves 94 eligible participants and is funded annually through the U.S. Department of Education in the amount of $449,310.
UPWARD BOUND PHOTO RELEASE FORM (optional)
I, blanks, hereby give the right and permission to Upward Bound to publish, without cost, photographs taken of blank .
These photographs may be used in publications, including electronic publications, or in audiovisual presentations, promotional literature, advertising, or in other similar ways. No personal information will be given about the student in the photos. This document will be valid until revoked in writing to Upward Bound.
Signature of Parent/Guardian
Date

MonthDayYear
Date
I am agreeing to the above conditions to give the right and permission to Upward Bound to publish, without cost, photographs taken of myself.
Signature of Student
Date

MonthDayYear
Date

WRITING SAMPLE TO BE COMPLETED BY STUDENT

In an effort to better assess the applicant's motivation for applying and his/her writing skills, a writing sample is reqired. This writing sample will be used to help determine a participant's individual education plan. The sample should be at least two (2) paragraphs long. Please select ONLY one of the following topics:

1. If you had to select one person who had the biggest influence on your life, who would it be and why?

2. Describe an event in your life that you feel has impacted you today. Explain why.

3. Explain your future goals and the steps you must take to achieve them.
Complete your writing sample here.
Should be Empty: