U.S. Department of Education TRiO Programs Upward Bound Math and Science Fact Sheet (2015)

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1 U.S. Department of Education TRiO Programs Upward Bound Math and Science Fact Sheet (2015) Program Description The Upward Bound Math and Science program is designed to strengthen the math and science skills of participating students. The goal of the program is to help students recognize and develop their potential to excel in math and science and to encourage them to pursue postsecondary degrees in math and science, and ultimately careers in the math and science profession. Types of Projects Program services include: summer programs with intensive math and science training; year-round counseling and advisement; exposure to university faculty members who do research in mathematics and the sciences; computer training; and participant-conducted scientific research under the guidance of faculty members or graduate students, who are serving as mentors; education or counseling services designed to improve the financial and economic literacy of students; and programs and activities previously mentioned that are specially designed for students who are limited English proficient, students from groups that are traditionally underrepresented in postsecondary education, students with disabilities, students who are homeless children and youths, students who are in foster care or are aging out of foster care system or other disconnected students. Additional Information Services provided by the program include: Exposure to academic programs and cultural events Instruction in reading, writing, study skills, and other subjects necessary for success in education beyond high school Academic, financial, or personal counseling Tutorial services Mentoring programs Information on postsecondary education opportunities Assistance in completing college entrance and financial aid applications Assistance in preparing for college entrance exams Information on the full range of Federal Student Financial Aid programs and benefits Guidance and assistance on secondary school reentry or alternative education programs; entry into general educational development programs or postsecondary education Eligibility Who May Apply: (specifically) Institutions of higher education, public and private agencies and organizations including community-based organizations with experience in serving disadvantaged youth, combinations of such institutions, agencies and organizations, and as appropriate to the purposes of the program, secondary schools. Students must be eligible to participate in the Upward Bound program and must have completed the eighth grade. However, participants do not necessarily have to be participating in a regular Upward Bound program. Two-thirds of all participants must be low-income, potential first-generation college students. The remaining one-third must be low-income or potential first-generation college students.

2 Name: Student Application To be considered for participation in the Upward Bound Math & Science Program, please complete this application in it s entirety, obtain the appropriate signatures and submit it to your high school guidance counselor. The following must be completed and/or included with this application: 1. Student Application 2. Provide your annual house hold Income from you most recently filed tax return (if filed/if not a recipient of free/reduced lunch) 3. Counselor recommendation 4. Teacher recommendations (from two teachers; one has to be math or science) 5. Copy of student s most recent transcript and student s reading and math Acuity scores. If you have any questions or need additional information, you may contact the office at: Upward Bound Math & Science Metropolitan Community College P.O. Box 3777 Omaha, Nebraska (402) For Office Use Only Eligibility Accepted Letter Database Folder

3 Follow these simple instructions 1. Read the entire application before you start so you ll know exactly what you re filling out. 2. Please complete this application. If we cannot read all the information, we ll have to send it back causing unnecessary delays. 3. Make sure that you have all the required signatures before submitting the application. 4. Don t forget to include a copy of your most recent school transcript. 5. To make it easy just remember to use this checklist: Section A Section B Section C Section D Section E Section F STUDENT completes PARENT or GUARDIAN completes STUDENT and PARENT both need to sign STUDENT Essay GUIDANCE COUNSELOR Recommendation Form (from your guidance counselor) TEACHER Recommendation Form (you need two) At least one teacher recommendation form has to be filled out by a Math or Science teacher School Transcript If you have any questions, please feel free to call the Upward Bound Math & Science office at (402)

4 SECTION A Student Application Name Last First Middle Mailing Address Home Phone Number Street/P.O. Box City State Zip Code Cell Phone Address Social Security Number - - Gender Male Female Birthday U.S. Citizen Yes No Month Day Year Race (please check all that apply) American Indian/Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander Hispanic or Latino High School Cumulative Grade Point Average Current Grade Expected Year of Graduation Who referred you to Upward Bound Math Science?

5 With whom does the student live? (Please check only one): SECTION B Family Information (To be completed by parent or guardian) Both Parents Mother Father Legal Guardian Foster Care Other (please specify) Parents/Guardian Name(s) Home Phone Second Phone or Cell Phone Mother/Guardian Place of Work Work Number Address Father/Guardian Place of Work Work Number Address Do you receive free/reduced lunch? Yes No If you did not file an income tax return last year, what was your income? Taxable income $ Non-taxable income $ Education level of parents: Father/Legal Guardian Less than high school High school graduate Some college hours Two year college degree Four year college degree Completed vocational training Mother/Legal Guardian Less than high school High school graduate Some college hours Two year college degree Four year college degree Completed vocational training Number of brothers/sisters who completed college/vocational school Total number of members in household Emergency Contact Name Number The information contained in this application is for the use of the Upward Bound Math Science program only and will be held in the strictest confidence. For our own records, it is necessary that you complete forms entirely. Please certify that the information is correct and complete to the best of your knowledge by signing below. Parent/Guardian Name (please print) Parent/Guardian Signature Date

6 SECTION C UPWARD BOUND MATH & SCIENCE METROPOLITAN COMMUNITY COLLEGE AUTHORIZATION FOR RELEASE OF EDUCATIONAL RECORDS (And additional release information) Please read all of the following information before signing. All information will be kept confidential. I hereby grant authorization for my educational records (grades, transcripts and test scores) to be released to the Upward Bound Math & Science program at Metropolitan Community College. I understand that the Upward Bound Math & Science program will request grades at the conclusion of each grading period and transcripts/test scores at least annually. We understand that Upward Bound Math & Science is for students who are able to handle the responsibility of being on campus daily for the 6 week summer component and mature enough to participate in chaperoned educational experiences for approximately one week away from home. We recognize that Upward Bound Math & Science is a major investment by the United States Department of Education and we understand that if the student is accepted and wishes to attend; he or she will be expected to be in attendance the entire 6 week summer program period. We understand that although travel costs and fees are provided free of charge, the student s family or guardian must assume responsibility for illnesses (including prescription coverage) or pre-existing conditions, medical release forms and any information needed to complete them. We understand that if the applicant is accepted by the Upward Bound Math & Science program, he or she will have to adhere to the program s rules and regulations concerning student responsibility and behavior in the academic and summer programs. We understand that the Director and Metropolitan Community College administrators will have the right to dismiss any student whose behavior is incompatible with the goals and standards of the Upward Bound Math & Science program. In consideration of acceptance of this application for the Upward Bound Math and Science program at Metropolitan Community College, we hereby authorize Metropolitan Community College to use the student s image, likeness, name and comments in, but not limited to, photographs, videos, and audio recordings created or used for the purpose of publicity/marketing and advertising for the College. We agree that the student, if accepted into the Upward Bound Math & Science program, may participate in answering questionnaires as part of the program s evaluation. Student Signature Parent/Guardian Signature Date

7 . Metropolitan Community College Upward Bound Math and Science Omaha Northwest High School Omaha Public Schools Consent to Release Student Records Funded through the US Department of Education the Metropolitan Community College Upward Bound Math and Science program identifies and assists students, including those who qualify as first generation and/or low income, who have the potential to succeed in higher education. There is no charge for students or families to participate. The program provides academic, career, and financial coaching to its participants and encourages them to graduate from high school and continue on and complete a postsecondary education. In order for the Omaha Public School District to release confidential information to help with identifying needs and developing an intervention plan, a consent form signed by the legal parent/guardian must be on file at the School District. I understand that the Metropolitan Community College Upward Bound Math and Science Education Specialist and Director have limited access to my child s student records on the school district s student information system Infinite Campus. Organizations sponsoring and funding this program will receive student data in summary form for the purpose of program monitoring. By signing this enrollment and consent form, you consent to the following: I authorize the Omaha Public School District to allow access to or release the following student records to the Metropolitan Community College Upward Bound Math and Science Education Specialist and Director: Family contact information Schedule Attendance; Daily and Term Emergency Medical Conditions Grades; GPA Immunization records as needed for college visits Transcripts Ongoing communications with school personnel This Consent to Release Student Records expires upon any of the following events, whichever comes first: when my child no longer participates in the program, (agency to inform district) or when my child withdraws or transfers from the school or the school district or when my child graduates from high school (through November 1 st of the year following graduation for purposes of providing end of year data) when a letter revoking this consent is received by Omaha Public Schools, Student Information Services, 3215 Cuming Street, Omaha, Nebraska Student Information Please print - One student per consent form Student Last Name (legal): Student Number: Student First Name (legal): School: Northwest HS Grade: Student Middle Name (full): Agency/Program: MCC UBMS Home Address: Birth Date mm / dd / yy City: Zip: Gender: M / F Parent/Guardian Information Are you the legal guardian of this student? Yes / No If No, do not sign. Relationship to Student: Parent Last Name (legal): Parent First Name (legal): Parent Middle Name (full): Home Phone: Cell Phone: Work Phone: Parent/Guardian Signature: Date: mm / dd / yy Eligible Student Signature (age 18 or older): Date: mm / dd / yy Office Use Only Verified Flags Sections Initials

8 SECTION D Imagine that it is 10 years from now and you have accomplished your goals. In a well written essay, please describe your future life. Be specific (include where you went to college, your major and your career). Note: The information contained in this application is for the use of the Upward Bound Math & Science program only and will be held in strictest confidence. For our own record, it is necessary that you complete the form entirely. Please certify that the information is correct and complete to the best of your knowledge by signing below. Student s Signature Date

9 SECTION E Metropolitan Community College Upward Bound Math & Science Guidance Counselor Recommendation Form (One Required) Name of Applicant (print) Last First Middle Thank you for taking the time to fill out a recommendation form for the above named student. He/she is applying for admittance into the Metropolitan Community College Upward Bound Math & Science Program. Due to the intensive nature of study and the 6 week academic experience during the summer, it is necessary to select only those students who demonstrate nor only an interest in furthering their education, but have a strong social maturity as well. Please be candid and as honest as possible in your responses. All information will be kept in the strictest confidence! Please return this recommendation form, along with the student s application, to the Upward Bound Math & Science office. If you have any questions or concerns please contact the Upward Bound Math & Science office at (402) Please rate the applicant on each of the characteristics listed below: Outstanding Excellent Good Fair Poor Academic performance Problem solving ability Communication skills Judgment and common sense Ability to deal with others Sensitivity to needs of others Emotionally stability & maturity Independence Integrity Dependability and reliability Persistence & motivation Leadership Willingness to follow directions Punctuality Initiative Ability to work beyond normal requirements of a task Grooming and appropriate dress Ability to live away from home for one week. Please check if student completed the Following course(s) by the end of the 8 th grade Please check the appropriate score for the student s 8 th grade NeSA Test: Pre-Algebra Algebra Geometry Physical Science Biology Below Meets Standards Math Science Student achieved a GPA of 2.5 or better for the most recent school year Yes No Exceeds Standards Print Name Title/Department Signature High School Additional Comments:

10 SECTION F METROPOLITAN COMMUNITY COLLEGE UPWARD BOUND MATH & SCIENCE Teacher Recommendation Form (Two required) At least one teacher form must be filled out by a Math or Science teacher Name of Applicant (print) Last First Middle Thank you for taking the time to fill out a recommendation form for the above named student. He/She is applying for admittance into the Metropolitan Community College Upward Bound Math & Science Program. Due to the intensive nature of study and the academic experience during the summer, it is necessary to select only those students who demonstrate not only an interest in furthering their education, but have a strong social maturity as well. Please be candid and as honest as possible in your responses. All information will be kept in the strictest confidence. Please give the recommendation form to the Guidance Counselor and he/she will put it with the student s Upward Bound Math & Science application. If you have any questions or concerns, please contact the Upward Bound Math & Science office at (402) Please rate the applicant on each of the characteristics listed below: Outstanding Excellent Good Fair Poor N/A Academic performance Problem solving ability Communication skills Judgment and common sense Ability to deal with others Emotional stability and maturity Independence Integrity Dependability and reliability Industry and persistence Leadership Willingness to follow direction Initiative Ability to work beyond the normal requirements of a task Groom and appropriate dress Ability to live away from home for one week Print Name Title/Department Signature High School Additional comments:

11 SECTION F METROPOLITAN COMMUNITY COLLEGE UPWARD BOUND MATH & SCIENCE Teacher Recommendation Form (Two required) At least one teacher form must be filled out by a Math or Science teacher Name of Applicant (print) Last First Middle Thank you for taking the time to fill out a recommendation form for the above named student. He/She is applying for admittance into the Metropolitan Community College Upward Bound Math & Science Program. Due to the intensive nature of study and the academic experience during the summer, it is necessary to select only those students who demonstrate not only an interest in furthering their education, but have a strong social maturity as well. Please be candid and as honest as possible in your responses. All information will be kept in the strictest confidence. Please give the recommendation form to the Guidance Counselor and he/she will put it with the student s Upward Bound Math & Science application. If you have any questions or concerns, please contact the Upward Bound Math & Science office at (402) Please rate the applicant on each of the characteristics listed below: Outstanding Excellent Good Fair Poor N/A Academic performance Problem solving ability Communication skills Judgment and common sense Ability to deal with others Emotional stability and maturity Independence Integrity Dependability and reliability Industry and persistence Leadership Willingness to follow direction Initiative Ability to work beyond the normal requirements of a task Groom and appropriate dress Ability to live away from home for one week Print Name Title/Department Signature High School Additional comments: