Upward Bound 2018-2019 Application

Upward Bound is a grant-funded program from the U.S. Department of Education. The purpose of our program is to prepare students to graduate from high school and college. Students who are accepted must participate in weekly Saturday sessions and a mandatory summer session for all 4 years of high school.

Students must meet certain federal guidelines to qualify and must attend Corcoran, Henninger, or Nottingham High School in the fall of 2019.

The application process involves students and parents/guardians completing the form below, as well as teachers and guidance counselors submitting letters of recommendation and an official report card. Finalists and their parents/guardians will be invited for in-person interviews and additional paperwork will be required. There are a limited number of available spaces for Upward Bound, so it is important that your completed application be submitted as soon as possible.

Please know that Upward Bound enforces the United States Department of Education guidelines to ensure confidentiality and to strictly guard your family's private information. The information you provide is required for eligibility reasons.

Applications will not be processed without all sections of the application having been completed.

If you have any questions or require additional information, please contact me at either blackka@lemoyne.edu or (315) 445-4532. Please visit our website at www.lemoyne.edu/upward_bound.

Sincerely,

Kenyon A. Black, Director

First Name Middle Name Last Name

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Area Code Phone Number

African American Hispanic/Latino European American Native American Asian American (Vietnamese, Japanese, Chinese, etc)

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First Name Middle Name Last Name

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Area Code Phone Number

Place of Employment
Occupation
Employer Address	Work Phone Number
Length of Employment in Years	Country

Per week Biweekly Per month Per year/annual N/A

None Grade School (1-8) High School / GED Technical School / Some College Associate Degree Bachelor / Graduate Degree N/A (Single parent household)

First Name Middle Name Last Name

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Area Code Phone Number

Place of Employment
Occupation
Employer Address	Work Phone Number
Length of Employment in Years	Country

Per week Biweekly Per month Per year/annual N/A

None Grade School (1-8) High School / GED Technical School / Some College Associate Degree Bachelor / Graduate Degree N/A (Single parent household)

Number of people in household

	Amount per month (enter $0 if none)
Public Assistance
Food Stamps
Unemployment Insurance
Social Security Income (SSI)
Child Support
Other

Parent Signature (First and Last Name)

Student Signature (First and Last Name)

Date of Signatures Date Picker Icon

First Name Last Name

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Upward Bound 2018-2019 Application

Student Personal Information

Academic Information

Verification of US Citizenship / Residency

Parent/Guardian Data: Mother/Guardian 1

Parent/Guardian Data: Father/Guardian 2

Household Income

Essay Questions

Required Documents