DVCUB PARENT (ENGLISH) Program Application
  • UPWARD BOUND PROGRAM APPLICATION - PARENT/GUARDIAN APPLICATION

    The Upward Bound Program (UB) at Diablo Valley College (DVC) is a year-round, pre-college program designed to assist high school student’s transition to college. Upward Bound works in collaboration with the schools, colleges and the community to provide educational opportunities and support to achieve these goals. We are currently recruiting at all grade levels at Concord, Mount Diablo, and Ygnacio Valley High School.
  • Eligibility Requirements 

    • Enrolled at Concord, Mount Diablo, OR Ygnacio Valley High School
    • Low Income and/or potential first-generation college student

    Services Available 

    • Preparation for high school graduation and college admissions tests
    • Assistance and guidance in following a college preparatory curriculum
    • Information and assistance in completing college applications and financial aid forms
    • Bi-monthly seminars and academies on Saturdays (Saturday Academy)
    • Daily, non-residential summer program (Six Week Program)
    • Exploration of educational and career opportunities
    • Weekly tutoring in core academic subjects
    • Educational, cultural and college field trips
    • Summer bridge program for graduating seniors

    Application Checklist 
    Please ensure that the necessary items in the checklist below have been attached prior to submitting your application.

    • Meet Eligibility Requirements
    • Complete and Submit Upward Bound Application
      • Submit all application parts through JotForm Links: Student Application, Student Self-Assessment, and Parent Application (Parent Application in Spanish)
      • Student name and/or signature on all pages where applicable
      • Acknowledge Upward Bound Student Commitment on page 2
    • Have teachers complete the Teacher Evaluation Forms through JotForm (English, Math, and Science (or Foreign Language) Teachers)
    • Submit Required Documents to the TRIO Program Director upon request 
      • Proof of Citizenship
        • US Citizenship (Copy of Social Security Card) or
        • Legal Residency (Copy of Alien Registration Card or
        • Pending Residency Status (Copy of Notification of Application Letter)
      • Income Verification of Parent /Guardian (Only one of the following signed copies of documentation must be attached)
        • Copy of tax form (1040) for 2025 or
        • Copy of Unemployment for 2025 or
        • Copy of AFDC/TANF Annual Statement for 2025 or
        • Copy of Annual Social Security Benefits Statement for 2025
    • Student Interview (TO BE SCHEDULED)
    • Parent Interview (TO BE SCHEDULED)

    Lastly, once the application is completed and submitted the Student and Parent/Guardian will receive an acceptance letter by mail.

    For questions or assistance with this application, please contact our program staff:
     Interim Program Coordinator - Miranda Rosas at (925) 969-2121 or mrosas@dvc.edu
    Program Assistant - 
    DVC Upward Bound Office -  Ramona Harrell-McCoy at (925) 969-2194 or rharrell-mccoy@dvc.edu

    THIS PAGE IS FOR YOUR RECORDS TO KEEP.

  • Information About Student Applying to Upward Bound

    Please fill in the information about your student

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  • Parent/Guardian 1

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  • Mother/Guardian

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  • The financial information requested is required by the US Department of Education to determine your child’s eligibility for Upward Bound. Please be advised that the program may request additional documentation.

  • I/we the parent(s)/guardian(s) of the above named student had an annual taxable income (see line 15 on 1040) of $*   for 2025. This income supported *(number of people, including all people who were supported by income).

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  • Parent / Guardian Obligation

  • I understand that the purpose of the DVC Upward Bound Program is to prepare participants to successfully complete a program of post-secondary education. As part of my personal effort in this preparation, should my child be admitted to the program, I commit to Upward Bound and intend to participate in all academic year and summer program activities organized and sponsored by the program for parents.

    I further understand that my and my child’s attendance and participation is extremely important. Therefore, should my child be admitted, I agree to ensure his/her attendance and active participation in tutoring (at least twice a week), Saturday College (bi-monthly), summer courses (6 weeks), meetings (monthly) and activities sponsored by Upward Bound. I understand the DVC UB Student Participation Guidelines and agree that my child must meet minimum participation requirements or jeopardize program enrollment (refer to attachment

    I, (Insert Parent/Guardian's Name), do hereby give permission for my child, (Insert Child's Name), to participate in supervised online activities (educational, academic, social, cultural, college, career and other college matriculation services) with staff from the Contra Costa Community College District and DVC Upward Bound. I understand that this will require my child to interact, exchange information and provide photos of required documents/progress of assignments with staff in an online format (i.e. Zoom, Calendly, Loom, Google Classroom, Remind, TAWK, On Track, College Choices, CANVAS, UC Scout, Khan Academy, AES, NWOW, JotForm, and social media).

    I will comply with all rules and regulations of the DVC Upward Bound Program and I am aware that failure to comply with the rules and regulations as well as the failure to fulfill the commitment to the program could result in my child’s dismissal from the program.

    I have read and understand my commitment to meeting the expectations of the DVC Upward Bound Program.

    Information Release: I would like my child to be a part of the DVC Upward Bound Program and hereby give permission for my child to participate in all activities. I/We authorize the DVC Upward Bound (UB) to obtain documents information relative to and consistent with my child’s education. Examples of these documents may include and are not limited to a copy of my child’s school transcript, test scores, ACT/SAT or GED scores, and school lunch program eligibility. I/We authorize UB to obtain information related to my child’s application for receipt of student financial assistance (federal, state, or other), a copy of my child’s award notification from the financial aid office, college admission acceptances and registration information. I give my child’s college of attendance and National Student Clearinghouse permission to disclose my child’s college enrollment status and degree attainment data to the CCCCD/DVC UB staff for the purpose of tracking my child’s college enrollment and completion. I hereby give my permission for my child’s name, photograph, work, and/or statements to be used by Diablo Valley College/UB for promotional, publicity (web pages, social media, brochures, newspaper, etc, or instructional purposes.

    I attest to the fact that all information in this application packet is true and accurate to the best of my knowledge.

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  • Please attach your child's IEP/504

    You marked that your child has a physical or learning disability at the beginning of this application. Please upload your child's IEP / 504. You can take a photo or scan the document(s) and them upload here.
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  • Please Submit the Parent/Guardian Application

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  • For questions or assistance with this application, please contact our program staff:

    Interim Program Coordinator || Miranda Rosas at mrosas@dvc.edu

     Program Assistant ||

    Ramona McCoy, Office Assistant || rharrell-mccoy@dvc.edu

    100% Federally Funded:                 Total Annual Budget UBI $309,505 | UBII $226,970

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