FACT SHEET TRIO UPWARD BOUND PROGRAM HAMPTON UNIVERSITY

FACT SHEET TRIO UPWARD BOUND PROGRAM HAMPTON UNIVERSITY
The Upward Bound Program, at Hampton University has served high school students since the 1960’s. The program is designed to aid participants in transitioning and completing a post secondary program of study after graduating high school. The participants must be enrolled in Newport News Public Schools in one of the following schools: Denbigh, Warwick, Heritage, or An Achievable Dream High Schools. The participants must have a demonstrated academic and finan- cial need and exemplify potential for success in education beyond high school.
- While in Upward Bound participants will be offered:
- Academic tutoring
- Advice and assistance in postsecondary school and course selection
- Preparation for successful completion of college entrance exams
- Information on federal Pell grant awards, loan forgiveness, and scholarships Assistance completing applications for federal student aid, as well as guidance with secondary school reentry Exposure to college tours, career shadowing, cultural enrichment activities, and more
In addition to these services, Upward Bound staff offers a six-week non-residential Summer En- thth richment Academy for rising 9-12 graders with an emphasis on increasing student achieve- ment; and a non-credit Summer Bridge Program for our recent graduates with an emphasis on transitioning to college or other post-secondary endeavors.

ELIGIBILITY: In order to qualify for initial acceptance to Hampton University’s Upward Bound Program, the student must:

Meet the income eligibility criterion established by Federal Guidelines Be a potential first-generation college bound student (neither of whose parent (s) received a baccalaureate degree) Be a citizen or national of the United States Be at least 13 years old (and no more than 19 years old) a rising 9 grader to a rising 12 grader at the time of acceptance
- Have a need for academic support in order to successfully pursue a program of study in
educa-tion beyond high school.
APPLICATION CHECKLIST
The following documents should accompany the application when it is submitted:
Form

Evidence of family income 1040, 1040A, or 1040EZ TaxSocial Security numberRecommendation for the program by adult other than
relative. (Example: guidance counselor, coach, teacher, clergy, or civic leader)

Student current report card or Transcript
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
2024-25 Hampton University Upward Bound
Student Application & Program Eligibility Form
Dr. Gregg Suzanne Ferguson, Director
OFFICE USE ONLY
Hampton University Upward Bound Program

97 Marshall Ave. Academy Building, 2nd Floor
Date Received

MonthDayYear
Date
Init
Init
Student Information (Please Print):
Date of Application

MonthDayYear
Date
Name
Date of Birth

MonthDayYear
Date
First Middle Last
Age
Preferred Name
Social Security Number
Address
Address
Gender
Yes
No
Home Phone
Home Phone

Do you send/receive texts? Yes NoStudent Cell:
Student Cell
Student personal Email
example@example.com
Student NNPS Email
example@example.com
Upward Bound Participating High School: (Must check ONE)

An Achievable DreamDenbighHeritage
Upward Bound Participating High School: (Must check ONE)

Student NNPS Email:
Denbigh

; 9th grade; 10th grade; 11th grade; 12th gradeWarwick
Current Grade Level (Must check ONE):
Parent 1 Information (Please Print)

Do you send/receive texts? Yes NoDo you send/receive texts? Yes NoParent 2 Information (Please Print):First Middle Last
Parent 2 Information (Please Print):
Name
Name
First Middle Last
Relationship to student
Relationship to student
EMAIL ADDRESS
example@example.com
EMAIL ADDRESS
example@example.com
Address
Address
Address
Address
Home Phone
Home Phone
Cell Phone
Cell Phone
Place of Employment
Place of Employment
Hampton University Upward Bound Program Eligibility Documentation
Family/Guardian Information
With whom does the student live?

Both parentsOne parentGrandparent (s)Parent and StepParentFoster familyLegal guardianAll information shared with the Hampton University Upward Bound Program is strictly confidential and is used solely for determining student eligibility for project participation.
Legal guardian

Text? Yes NoOther
Name 1
Relationship to student
Address
Address
Cell Phone
Home Phone
How often? Full time Part time Describe
Name:2
Relationship to student:.
Relationship to student:.

Text? Yes NoCell Phone
Address
Address

How often? Full time Part time Describe:Home Phone
Cell Phone
Home Phone
Home Phone
How often? Full time Part time Describe
Please list your brothers and/or sisters with their ages and current grade level

Address
Name
Name

Grades 1-8 9 10 11 12 GEDEducational Completion (Please Circle)Parent 1 NameGrades 18 9 10 11 12 GEDParent 2 NameSection A Educational Completion of Parents or GuardiansEducational Completion (Please Circle)Enter the information pertaining to the adult (s) with whom the student resides.The HU Upward Bound Program is designed to serve students from families with the most financial need, where neither parent has completed a fouryear college degree.Program DocumentationAgeGrade
Name

other
Age
Parent 1 Name
Parent 2 Name
other

High School Diploma Certificate ProgramHigh School Diploma Certificate ProgramotherName
Hampton University Upward Bound Program Eligibility Documentation
Income Documentation In the case of divorce, please list the parent who claims the student on their
federal tax form. Print Name on Income Proof:
How many people live in your household? (include children away at school/college/other)
Section C - 2023 Taxable Income
If you are not required to file a tax return, please select the first income range. Do not use your Adjusted Gross Income AGI amounts located on the first page of your tax return It is usually higher than taxable income

$021,871$29,581$37,29145,001
If you are not required to file a tax return, please select the first income range. Do not use your Adjusted Gross Income AGI amounts located on the first page of your tax return It is usually higher than taxable income

56,25160,421$68,131
Please check the taxable income range that is reflected on your 2022 or 2023 tax forms. This amount can be found on your IRS 1040 form (LINE 43), 1040-EZ form (LINE 6) or 1040-A form (LINE 27
Parent/Guardians Signature
Date

MonthDayYear
Date
Hampton University Upward Bound Student Academic/Aspiration Status
Academic Ability: If you know your grade point average (GPA), please list it here.
Please List Your Current Classes and Grades
Classes
Grades
Classes
Grades
1.
5.
5.
2.
6.
6.
3.
7.
7.
4.
8.
8.
Need for Program Services:
Please check the services you are most interested in receiving from the HU Upward Bound Program

Academic tutoringEducational planningSOL preparationPersonal counselingCollege admissions assistanceFinancial aid assistanceCollege tours/selectionCareer awareness
Educational Plans After High School Graduation
I plan to attend a 4year public or private

I am undecided about my educational goals.college./universityI have no educational plans after high school.I plan to enter the workforce.I plan to attend a community college.I plan to join the military
Planning Your Future
List four college choices
List four college choices
List four college choices
List four college choices
List four career choices
List four career choices
List four career choices
List four career choices
Hampton University Upward Bound Student Academic Expectations
Page 5
High School Degree Completion
High School Curriculum: Upward Bound students must be enrolled in college preparatory classes, which means students will take a rigorous plan of study due to Upward Bound

focus to assist students to be college and career ready. Rigorous curriculum includes: 4 English credits, 4 Math credits (including Algebra I & II, and Geometry), 4 Science credits (biology and chemistry must be included), 4 Social Studies credits, and 3 Foreign Language
credits. Students must pass the required SOLs needed for receiving the specific high school diploma. Which high school diploma do you plan to attain?

Standard Diploma 22 creditsAdvanced Diploma 26 credits
Please rank the following academic areas (1 indicates your highest interest)
Math
Math
Science
History
Language Arts
The HU Upward Bound program is funded by the US Department of Education to serve eligi- ble students from Newport News Public Schools at Achievable Dream, Denbigh, Heritage, and Warwick high schools. This is a yearround educational experience. Upward Bound

students are required to maintain a minimum 2.5 semester grade point average through- out high school, attend weekly afterschool and/or inschool meetings, participate in program travel, attend tutoring, and participate in at least one summer program held on the HU campus.

My signature below indicates, to the best of my knowledge that the information provided on this form is accurate and we understand the Upward Bound Academic Expectations.
Student Signature Date Parent/Guardian Signature

MonthDayYear
Date
Student Signature Date Parent/Guardian Signature

MonthDayYear
Date
Student Signature Date Parent/Guardian Signature

MonthDayYear
Date
Student Signature Date Parent/Guardian Signature

MonthDayYear
Date
Date
Hampton University Upward Bound Program Student Commitment
The Upward Bound Programs are committed to providing educational support for selected participants. These programs are designed to work with a select group of students throughout their high school experience and track their progress through postsecondary education. Parents and students must fully understand the commitment they are making to the HU Upward Bound Program and the investment the program is making in each participant.
Student Commitment Statement:
Please initial each statement.

As a member of the HU Upward Bound Program, I understand that my commitment to this program assists me in going to college and obtaining a fouryear college degree. My personal actions and mannerisms will

be collegegoing behaviors and includes:
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Maintaining a minimum 2.5 semester grade point average;

Successfully completing the appropriate Standards of Learning Tests, and providing end of

year SOL scores and final grade report cards to Upward Bound staff;
Participating in a minimum of one complete Summer Program, including the
Participating in afterschool, inschool, or Saturday meetings, testing, tutoring, and field
Following the dress code, rules and regulations of the HU Upward Bound Program and
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Not receiving inschool or out of school suspension upon being accepted into this program;

Not using or being in the possession of tobacco products, alcohol or other abusive

substances, including vaporproducts during program activities or while on school or
Not being in the possession of firearms or other weapons during program activities or
while on school or college property;
Enrolling in college preparation courses throughout high school which includes a rigorous
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Exhibiting positive behaviors and attitudes towards students and staff;

Enrolling in college upon graduation from high school, and

Graduating from college with a twoyear degree (in 3 years or less) and/or a fouryear

Our signatures below indicate that we have reviewed the commitment statements and agree to abide by the regulations and policies that govern participation in the HU Upward Bound Program. I also understand that failure to uphold any part of this commitment may warrant dismissal from the Hampton University Upward Bound Program.
Students Signature
Date

MonthDayYear
Date
Parents Signature
Date

MonthDayYear
Date
Hampton University Upward Bound Program Parent Commitment
The following information has been reviewed with me during the parent interview for the HU Upward Bound Program. Please initial each statement.
The following information has been reviewed with me during the parent interview for the HU Upward Bound Program. Please initial each statement.
The following information has been reviewed with me during the parent interview for the HU Upward Bound Program. Please initial each statement.
The following information has been reviewed with me during the parent interview for the HU Upward Bound Program. Please initial each statement.
The following information has been reviewed with me during the parent interview for the HU Upward Bound Program. Please initial each statement.
I give my permission for my child to participate in scheduled classes, afterschool

programs, Saturday seminars, tutoring, field trips, testing, college visitations and

cultural experiences provided by the HU Upward Bound Program.

I will be responsible for transporting my child to and from the local high school

and/or the Hampton University campus. I give permission for my child to be

transported by county school bus, college vehicles and /or commercial chartered

buses for field trips, college visitations, or other general program needs.

I give permission for the HU Upward Bound staff to access my students class

schedule, grades, standardized test scores, SOL scores, and financial aid

documentation for the purposes of meeting program requirements.

I understand that the HU Upward Bound staff is required to track my child

progress from high school through college graduation and will supply uptodate

college addresses and information as needed.

The HU Upward Bound staff has my permission to make a record of my student's

activities (e.g. videotape, audio tapes, movies or photographs) while engaged in

program activities. This material may be used only for program publicity,

teacher inservice training, or professional conference presentations.

I understand that my child may be dismissed from the HU Upward Bound for

failing to comply with program regulations. Immediate removal from the program will occur if my child is in possession of tobacco, alcohol, drugs, firearms

or other weapons at school or during program activities, or in violation of the

Hampton University Code of Conduct.

I assume responsibility for any damage to the programs technology, damage to

the college, high school or other facilities brought about by my child.

I understand that upon acceptance to this program, my student will attend at

least one complete Summer program, including the end of summer tripFamily vacations, church camps, 4H camps, sports camps, band camp, Boy/Girl Scout camps, etc. must be planned around the UB commitment.
I understand that HU Upward Bound employees are required to report to the proper authorities any of the following information disclosed by students
I understand that HU Upward Bound employees are required to report to the proper authorities any of the following information disclosed by students
If the student expresses plans to harm themselves or commit suicide. If the student expresses to an employee that he or she is being neglected or abused. If the student is harassing or abusing another individual. If the student expresses an intention to harm another person.
Our signatures below indicate that we have reviewed the commitment statements and agree to abide by the regulations and policies that govern participation. I also understand that failure to uphold any part of this commitment may warrant dismissal from the Hampton University Upward Bound Program.
Our signatures below indicate that we have reviewed the commitment statements and agree to abide by the regulations and policies that govern participation. I also understand that failure to uphold any part of this commitment may warrant dismissal from the Hampton University Upward Bound Program.
Student’s Signature Date

MonthDayYear
Date
Parent’s Signature
Date
Should be Empty:

FACT SHEET TRIO UPWARD BOUND PROGRAM HAMPTON UNIVERSITY

APPLICATION CHECKLIST

2024-25 Hampton University Upward Bound

Hampton University Upward Bound Program Eligibility Documentation

Family/Guardian Information

Hampton University Upward Bound Program Eligibility Documentation

Section C - 2023 Taxable Income

Hampton University Upward Bound Student Academic/Aspiration Status

Please List Your Current Classes and Grades

Classes

Classes

Grades

Need for Program Services:

Educational Plans After High School Graduation

Planning Your Future

Hampton University Upward Bound Student Academic Expectations

Page 5

High School Degree Completion

Date

Hampton University Upward Bound Program Student Commitment

Student Commitment Statement:

Hampton University Upward Bound Program Parent Commitment

Date