TRIO Upward Bound Application

Parent/Guardian Information
In this section, please provide information regarding your Father/Parent 1.
Full Name*
Relationship to you (ex: father, etc)
Cell Phone Number
Email
example@example.com
Does this parent have a Bachelor's degree or higher (completed 4-year college degree or higher)?

YesNo
In this section, please provide information regarding your Mother/Parent 2.
Full Name (Mother/Parent 2)*
Relationship to you (ex: mother, etc)
Cell Phone Number
Email
example@example.com
Does this parent have a Bachelor's degree or higher (completed 4-year college degree or higher)?*

YesNo
Do you live with and receive more than half support from:*

Father/Parent 1Mother/Parent 2Both
Number in family*
Annual Taxable Income: Taxable income can be found on line 15 on the Form 1040. Please use the tax return from the most recently completed tax year.*
Are you a ward of the court, in foster care, or an emancipated minor? If yes, please submit applicable documentation to the Upward Bound office.*

YesNo

Signatures
By signing this application, I hereby certifcy that, to the best of my knowledge, the information provided on this document is true and accurate.
Student Signature*

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Date*

MonthDayYear
Date
Parent Signature*

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Date*

MonthDayYear
Date

Student Essay
Please explain how your participation in the Upward Bound Program will benefit you in reaching your academic goals. Make sure you proofread your essay before submitting it to the Upward Bound Program.

Transcript Release Form
I, Parent's Full Name*, the parent of, Student's Full Name*, request that a copy of my child's current high school transcript and/or grade report be mailed to the Upward Bound Program at St. Louis Community College - Forest Park. The Upward Bound program also has my permission to receive transcripts and/or grade reports in the future while my child remains enrolled in the Upward Bound program.
Transcripts can be mailed to:

Manager, TRIO Upward Bound St. Louis Community College - Forest Park 5600 Oakland Avenue, W321 St. Louis, MO 63110

Transcripts can be emailed to:

fptrioupwardbound@stlcc.edu
Signature of Parent/Guardian*

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Date*

MonthDayYear
Date