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:25637
25661
A Federally Funded Program
STUDENT INFORMATION
Name of Applicant: ____________________________________________________________________
Last
First
Middle
Mailing Address: ______________________________________________________________________
Cell Phone: (
)____________________________ Home Phone: (
) ______________________
Email Address: _______________________________________________________________________
Social Security Number: _____________-________-_____________
U.S. Citizen:  Yes
Birthdate:___________________________________________
Ethnic Status:  Black or African American
 Hispanic or Latino
 White
 Asian
Gender:  Male
 Female
 No
 American Indian/Alaskan Native
 Native Hawaiian or Other Pacific Islander
Expected Year
Current School: ______________________________
Grade:________ Of Graduation: 20 _____
High School Counselor: ________________________________________________________________
Please select high school you will attend in the fall.
 Butler High
 Buckhorn High
 J. O. Johnson High
 Hazel Green High
 Lee High
 Sparkman High
 Other ________________________
Have you participated in any other TRiO Program?  Yes  No
(If yes, check all that apply)
 Upward Bound
 Talent Search
 Upward Bound Math-Science
 GEAR UP
FAMILY INFORMATION
(to be completed by parent or guardian)
With whom does the student live? Please check only one:
 Both Parents
 Mother
 Father
 Grandparent
 Foster Care
 Other (please specify) __________________________________________________________________
Parent(s) Marital Status:
Deceased?
 Mother
 Married, living together
 Single
 Married, living separately
 Divorced
 Father
Parent/Guardian: _____________________________________ Cell Phone: (
First
) ____________________
Last
Mother/Guardian
Employer: ______________________________________ Work Number: (
) ________________
Father/Guardian
Employer: ______________________________________ Work Number: (
) ________________
Alabama A&M Upward Bound Program  P.O. Box 347 Normal, AL 35762  (256) 372-5661
Www.aamu.edu/administrativeoffices/trio/pages/upward-bound.aspx
FAMILY INFORMATION (Continued)
A Federally Funded Program
Did you (the parent) file an Income Tax Return last year?
 Yes (if yes, you must include a signed copy of your FEDERAL return)
 No
If you did not file an Income Tax Return last year, what was your income?
TAXABLE INCOME $ _______________________________
Please indicate the source of untaxed income:
Social Security $________________________
Unemployment $_________________________
Retirement $__________________________
Child Support $___________________________
Veteran’s Benefit $ _____________________
Other (please specify) $_____________________________________________________________
Is there any unusual change in income over the last year?  No  Yes (if yes, please explain)
_________________________________________________________________________________
Select highest level of education completed
Mother/Guardian
Father/Guardian
 Less than high school
 High school graduate
 Some college hours
 Two years of college
 Four year college degree
 Completed vocational training
 Less than high school
 High school graduate
 Some college hours
 Two years of college
 Four year college degree
 Completed vocational training
Number of siblings who completed college/vocational school? _______________________________
List the name of each person that is a member of your household and their relationship to the student
NAME & RELATIONSHIP
NAME & RELATIONSHIP
Total number of members in your household: _________________
The information contained in this application is for the use of the Alabama A&M University TRiO-Upward Bound
Program and will be held in the strictest confidence. 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 ______________
Alabama A&M Upward Bound Program  P.O. Box 347 Normal, AL 35762  (256) 372-5661
STUDENT ESSAY
A Federally Funded Program
Write an essay,150 words or more explaining your interest in the program, educational
goals, career choice(s), and how you could benefit from the program.
The information contained in this application is for the use of the Alabama A&M University TRiO-Upward
Bound program and will be held in the strictest confidence. Please certify that the information is correct and
complete to the best of your knowledge by signing below.
Student Signature ____________________________________________ Date ______________
Alabama A&M Upward Bound Program  P.O. Box 347 Normal, AL 35762  (256) 372-5661
Alabama A&M University
TEACHER EVALUATION
Name of Applicant: ___________________________________________________________________
Last
First
Current School: _______________________________________
Middle
Grade:
8
9
10
11
(Please Circle One)
Teacher: ______________________________________________________________________
Please rate the student in each of the following areas by circling
the appropriate number with 5 being highest
Attitude
Peer Relationships
Desire to Learn
Participation in class
Completing Assignments
Respect for Authority
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
Comments
5
5
5
5
5
5
Student Strengths: _______________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
Student Weakness:_______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Recommendations/Additional Comments: ____________________________________________
________________________________________________________________________________
______________________________________________________________________________
Teacher Signature ____________________________________________ Date ______________
Please return this form to the student in a sealed envelope
with the student’s name on the front
or mail to:
Alabama A&M University
TRiO-Upward Bound Program
P.O. Box 347
Normal, AL 35762
Alabama A&M Upward Bound Program  P.O. Box 347 Normal, AL 35762  (256) 372-5661
Alabama A&M University
TEACHER EVALUATION
Name of Applicant: ___________________________________________________________________
Last
First
Current School: _______________________________________
Middle
Grade:
8
9
10
11
(Please Circle One)
Teacher: ______________________________________________________________________
Please rate the student in each of the following areas by circling
the appropriate number with 5 being highest
Attitude
Peer Relationships
Desire to Learn
Participation in class
Completing Assignments
Respect for Authority
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
Comments
5
5
5
5
5
5
Student Strengths: _______________________________________________________________
________________________________________________________________________________
______________________________________________________________________________
Student Weakness:_______________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Recommendations/Additional Comments: ____________________________________________
________________________________________________________________________________
______________________________________________________________________________
Teacher Signature ____________________________________________ Date ______________
Please return this form to the student in a sealed envelope
with the student’s name on the front
or mail to:
Alabama A&M University
TRiO-Upward Bound Program
P.O. Box 347
Normal, AL 35762
Alabama A&M Upward Bound Program  P.O. Box 347 Normal, AL 35762  (256) 372-5661