CBI- TRIO Application

College Bound Institute- Atlanta, GA TRIO Program

This is a FREE program for middle and high school students at targeted schools sponsored by a grant from the U.S. Department of Education. The program provides academic, career, and financial counseling to all participants and encourages them to graduate from high school and continue on to and graduate from college. Program services include: tutoring, counseling, college application assistance, scholarship and financial aid assistance, SAT/ACT prep, college tours and other educational field trips. All interested students must complete an application to be considered for enrollment. Please have a parent present to help complete the application.
Student Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Date of Birth
Student ID Number
Sex
Citizenship
Ethnic Group
Are you physically challenged?
School Name
Grade Level
What Cubs, Programs or Organizations are you a member of?
Services Offered (Please Select All That Interest You)
What are your plans after graduating high school?

Please list two teachers who would give you a recommendation to be in this program:

Rows	Last Name	Class Subject
1
2

Please tell us a little about yourself and your life goals. (Please write at least 4 sentences)
Parent's Information

A parent or legal guardian will need to complete this portion of the application.
Parent's Name

First NameLast Name
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent's E-mail
example@example.com
Number of people in Parent's Household
Parent's Education Level
Parent's Marital Status
Parent's Annual Income
Do you the parent, file taxes?
Does your child qualify to receive Free or reduced lunch at school?
Does your family qualify to receive assistance from any of the following sources?
Parent's Signature- By signing below, you verify that the above information and income data is correct to the best of your knowledge. Furthermore, your signature verifies your understanding that all information you have provided is confidential.
I, Parent's Name* do authorize the staff of the College Bound Institute- TRIO Program to obtain copies of Student's Name* transcripts, report cards and all test scores throughout his/her high school years. I understand that this information will be held in strict confidence and will be used to evaluate my child’s progress to determine the effectiveness of the services rendered by the College Bound Institute- TRIO Program.

In addition, I hereby authorize any school, college/university, or third-party entity to release any academic or financial aid information (to include a copy of our application for free and reduced meals) from my files that is requested by the College Bound Institute- TRIO Program. All information obtained by the program mentioned above is completely personal and confidential and is only used for verification of eligibility or enrollment in postsecondary institutions.
Signature
Should be Empty:

College Bound Institute- Atlanta, GA TRIO Program

Student Information

Parent's Information