UP Eligibility Review Form

Applicant Information:

The following questions will allow us to complete an initial review of you eligibility. It is not the full and complete application. If eligible to apply, you will receive an email with a link to the full application. If not eligible, you will receive an email with an explanation as to why you are not eligible at this time.
Full Name*

First NameLast Name
E-mail*
Re-enter your email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Educational Program*
Expected Graduation date: *

MonthDayYear
If you do not know the exact date, put the last day of the month you plan to graduate.
Name of College/Institution: *
Major/Concentration*
How many children do you have? *
Ages of each of your children*
Include the numerical age separated by a comma for each child.
Uplifting Parents Eligibility Review

Mission: To create stability and greater opportunities for single parent families through relationship-based mentoring and wraparound supports throughout their higher-education journey.

We work toward this mission by providing support and resources to single parent students through five essential elements:
- Mentorship
- Financial Literacy & Assistance
- Case Management
- Parenting Education and support
- Community of Support
Mentoring is the heart of the program and helps provide the holistic services and support that will assist you in completing your degree or certification and achieving economic stability for your family.

ELIGIBILITY

The Uplifting Parents program provides support to single parent students. To be eligible for Uplifting Parents, candidates must meet the following minimum criteria:
- Single parent, male or female, seeking advancement in higher education
- Currently parenting at least 50% of the time or be an expectant mother
- Currently enrolled and attending classes or will begin classes in the next 30 days. Minimum of 6 credits per semester or the equivalent
- Be within 6-24 months of degree or certificate completion
- Have clear educational and career goals
- Be self-motivated and committed to personal and family growth
- Not currently experiencing substance misuse.
- Present stability in basic needs; not currently struggling in crisis.
- Be willing to meet with an UP mentor at least twice per month
- Provide required documents and complete surveys as requested
- Provide 2 referrals, one must be from an academic institution and referrals must not be family members or be a self-referral.
I meet all of the eligibility requirements as listed above:*

YesNo
If you do not meet all of the eligibility requirements listed above, please explain why:
Referral Partner

Uplifting Parents program is a referral program that requires you to be referred into our program. This person can be how you heard about our program but should also know you well enough to answer some questions related to their knowledge of you, your history, your motivation, your resources, etc. Please provide 2 referrals, one must be from an academic institution and referrals must not be family members or be a self-referral.
First Referral Name: *

First NameLast Name
Email*
example@example.com
Organization *
Second Referral Name:*

First NameLast Name
Email*
example@example.com
Organization:*
Educational & Career Goals:
Why are you pursuing this certificate or degree program? For example, a new career, promotion/pay raise at your current job, or goals that this certificate/degree will help you achieve. *
Provide as much detail as possible.
Share with us any other information or details you feel may be helpful for us to know. *

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Applicant Information:

Referral Partner

Educational & Career Goals: