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Trio Upward Bound

Eligibility Requirements

Upward Bound serves 9th through 11th grade students at Cortez, Durango, and Ignacio High Schools who are:

Income eligible (based on federal guidelines) and/or First Generation- neither parent has completed a 4-year college degree (preference is given to those who meet both criteria)
A U.S. Citizen or Permanent Resident
Motivated and have the potential for academic pursuits but need the encouragement, skill development and academic guidance necessary to go on to college
Willing to make a long-term commitment to Upward Bound and to work hard toward self-improvement through the program

Application Process

If you believe you meet eligibility requirements, apply now! Please fill out the application form below with your parent/guardian present as they will need to sign off on the information provided.

We will contact you after your application is received and follow up. If you need to contact us for any reason, please email us at temarriott@fortlewis.edu.

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Eligibility Verification Form
To be completed by parent or guardian
Student's name

First Name
Last Name
Is your student a U.S. Citizen?

Yes
No
If not, is the student a permanent resident?

Yes
No
Parent/Guardian 1
Name
Email
Relation to student

Address

Street Address
Street Address 2
City	State
Zip Code	Country

Cell Phone
Area CodePhone Number
Home Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
Parent/Guardian 2 (if applicable)
Name
Email
Relation to student
Check the box below if address is the same as parent/guardian above:

Same address as above

Address

Street Address
Street Address 2
City	State
Zip Code	Country

Cell Phone
Area CodePhone Number
Home Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
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Income Eligibility and First Generation Verification
To be completed by parent or guardian
To be eligible for TRIO Upward Bound, a student must be either income-eligible (based on family size and taxable income) or first-generation (meaning neither parent has completed a four-year/bachelor’s degree) or both. Students who meet both requirements will receive first consideration.

Please answer the following questions to the best of your knowledge based on your family situation. (Your application WILL NOT be reviewed without this information.)
Do either of the student’s biological parents have a 4-year college/bachelor’s degree?

Yes
No
If yes, which parent(s) and from what college(s)?
During the last year, how many people lived at home? (Please state the number of family members that you claimed on your tax return)
Last year, what was your TAXABLE income (not total or gross income)?
Form 1040 line #43, Form 1040A Line #27, Form 1040EZ Line #6. Important – Please make sure you list your TAXABLE income as this could affect the student’s eligibility into the program.
Please check all the services that your family receives:

TANF
Food Stamps/SNAP
Medicaid
Free/Reduced Lunch
WIC
SSI
**Please include a copy of the first two pages of your most recent tax return**
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Process
Status
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Affidavit
I, the undersigned (student), declare under penalty of perjury that all the information reported on this application is true, complete, and accurate to the best of my knowledge.
Electronic Signature
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Datetime
Month - Day - Year
I, the undersigned (parent/legal guardian), declare under penalty of perjury that all the information reported on this application is true, complete, and accurate to the best of my knowledge.
Electronic Signature
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Datetime
Month - Day - Year
I, the undersigned (parent/legal guardian), declare under penalty of perjury that all the information reported on this application is true, complete, and accurate to the best of my knowledge.
Electronic Signature
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Datetime
Month - Day - Year
Release of Records
These releases are effective throughout my high school and college careers and will be terminated only upon college graduation.

CONFIDENTIALITY OF INFORMATION

No one may access, view, or utilize your personal information unless they work with or for Upward Bound or unless they are given specific or legal authorization to said information. Your personal information is required to determine if your child meets federal eligibility guidelines established by regulation of the United States Department of Education. All information is protected under the Family Educational Rights and Privacy Act (FERPA, 20 USC 1231a). However, the Department of Education does have the authority to gather general statistical data about program participants in order to improve and measure the success of Upward Bound programs across the United States.
FERPA Form for the Release of Education Records to the Fort Lewis College TRIO Upward Bound Program

I, the undersigned student, hereby authorize the release of any of my educational records including transcripts, school enrollment status, academic standing, school credits completed, attendance, class schedules, degrees earned and/or any other information related to my educational performance to the Fort Lewis College TRIO Upward Bound Program.

The Fort Lewis College TRIO Upward Bound Program has my permission to obtain any information, data or financial aid award letters verifying my post-secondary enrollment and financial aid awarded. This includes retrieval of my college enrollment history from the National Student Clearinghouse online database system or directly from the college/university that I am attending.

The released information is for the purpose of verifying placement and retention in post-secondary education and will only be shared with program staff and the US Department of Education when the Annual Performance Report is submitted for evaluation of the program outcomes. I fully understand that the TRIO Upward Bound Program will use this information for program performance, tracking, and reporting purposes.

This authorization will remain in effect until I graduate from college and my degree is verified.
Student signature
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Student's name (printed)
Parent/guardian signature
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Parent/guardian name (printed)
Internet Policy
STUDENT’S INTERNET AGREEMENT

I , the undersigned student, agree to comply to the terms of the Fort Lewis College Acceptable Use and Internet Safety Policy.
Student signature
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Date
Month - Day - Year
PARENT/GUARDIAN AGREEMENT

As the parent or legal guardian of the above student, I understand and agree that my child or ward shall comply with the terms of the Fort Lewis Acceptable Use and Internet Safety Policy, for the student's access to the Fort Lewis College’s computer network and the Internet. I understand that access is being provided to the students for educational purposes only. I understand that it is impossible for Fort Lewis College to restrict access to all offensive and controversial materials and understand my child's or ward's responsibility for abiding by the Policy. I agree to indemnify and hold harmless Fort Lewis College and the Internet provider against all claims, damages, losses and costs, of whatever kind, that may result from my child's or ward's use of his or her access to such networks or his or her violation of the foregoing Policy. Further. I hereby give permission for my child or ward to use the Fort Lewis College computer network and the Internet.
Parent/guardian signature
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Date
Month - Day - Year
Parent/guardian signature
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Date
Month - Day - Year
Photo & Video Release Form
PHOTO & VIDEO RELEASE FORM

I, the undersigned, authorize the Upward Bound Program at Fort Lewis College to use photographs and/or video with my/my child’s image in Upward Bound publications and/or news releases.
Student signature
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Date
Month - Day - Year
Parent/Guardian signature
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Date
Month - Day - Year
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Apply Now
Trio Upward Bound

Eligibility Requirements

Application Process

Apply For TRIO Upward Bound

Student Information

Eligibility Verification Form

Parent/Guardian 1

Parent/Guardian 2 (if applicable)

Income Eligibility and First Generation Verification

Affidavit

Release of Records

Internet Policy

Photo & Video Release Form

Apply Now Trio Upward Bound

Eligibility Requirements

Application Process

Apply For TRIO Upward Bound

Student Information

Eligibility Verification Form

Parent/Guardian 1

Parent/Guardian 2 (if applicable)

Income Eligibility and First Generation Verification

Affidavit

Release of Records

Internet Policy

Photo & Video Release Form

Apply Now
Trio Upward Bound