2010-2011
What is Upward Bound?
Upward Bound is an academic support program designed to increase high school students’ opportunities to attend
college.
Who is eligible for Upward Bound?
The ETSU Upward Bound program serves high school students from Carter, Johnson, Unicoi, and Sullivan
county schools as well as Elizabethton, Johnson City, Kingsport, and Bristol city schools. Students must meet
one of the following criteria: 1) family income must meet federal guidelines, and/or 2) neither parent obtained a
degree from a four-year college.
Students start the program in the beginning of their freshman or sophomore year and remain in the program until
they begin their college career.
What academic support is available?
The program is designed to supplement the high school curriculum and is focused on individual student academic
need in all of their high school classes. Students will receive tutoring and advanced skill development geared
toward college preparation.
How can Upward Bound help students get into college?
Aside from providing an academic support system, Upward Bound provides workshops and individual counseling
sessions for financial aid and scholarship information for college, ACT preparation, and career planning. Upon
graduation from high school, Upward Bound students has the opportunity to enroll in a college class at ETSU.
The Upward Bound program provides tuition, tutoring, books, and supplies for these two summer classes.
Where and when does Upward Bound meet?
During the school year, Upward Bound has monthly meetings on Monday evenings at ETSU main campus. The
Upward Bound program provides transportation from designated pick-up points to ETSU and back to the
designated pick-up points for these academic sessions. During the summer, students participate in a six-week
residential program at ETSU main campus. The students attend classes in academic subjects such as
Mathematics, Science, Writing, Literature, and Computer Science. The summer schedule also offers a variety of
classes such as: art, crafts, music, dance and physical fitness activities. Upward Bound students also attend
several educational and cultural activities throughout the year. During the school year an Upward Bound
representative will visit each school once a week for a short meeting with each Upward Bound student.
What is the cost to participate in the Upward Bound program?
Program activities are provided at no cost to the student. Upward Bound is a federally funded program through
the U.S. Department of Education.
If you have any questions or concerns regarding the Upward Bound program at ETSU, please call 423439-5619 or visit our web site at http://why.ubetsu.org.
Dr. Ronnie Gross
John Davison
Chris Strode
Allie Pyles
TRIO Executive Director
Counselor
Bridge Counselor
Educational Advisor
Stephen Hendrix
Kim Oaks-Blair
Julie Kumar
Teresa Carver
Assistant Director
Counselor
Educational Advisor
TRIO Executive Aide
ETSU UPWARD BOUND
STUDENT APPLICATION
(Please print using blue or black ink)
For Office Use Only
Date received: __________________
FE____ FG___ Grade 9 10 11
DB SC SE SH SN SS TH
C
E
H
HV JC UC U
Comments: __________________
Name__________________________________________________________________________________________________________
First
Middle
Last
Address:________________________________________________________________________________________________________
City/State ______________________________________________________________________
Zip Code___________________
Phone#______________________________
E-Mail Address ____________________________________________________
Social Security #_________________________
Sex: ( ) Male
Racial/Ethnic Background (select all that apply):
____American Indian/Alaskan Native
____Asian
____Black or African American
( ) Female
Date of Birth__________________
____Hispanic/Latino
____White
____Native Hawaiian or Other Pacific Islander
Are you a United States citizen? _____yes _____no
High School_____________________________
Grade __9 __10 __11
What type of courses are you taking? (Please circle one.)
College Prep
Technical
Both
Why do you want to be in Upward Bound and how do you think Upward Bound can be of help to you in your
educational endeavors (please continue on the back of this page if necessary). Your essay will be scored on
grammar and content.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
East Tennessee State University is fully in accord with the belief that educational and employment opportunities should be available to all eligible persons without regard to
age, gender, color, race, religion, national origin, disability, veteran status, or sexual orientation. TBR 120-003-07 .5M
STUDENT ELIGIBILITY FORM
I. Family Income Information
A. IF YOU FILED INCOME TAX FORMS LAST YEAR (2009) - please complete the following.
The information we need is your family’s TAXABLE INCOME, NOT your total annual income. Taxable income is smaller than
total income. Taxable income is the amount on your tax return after all adjustments, exemptions and deductions have been
subtracted. This amount appears on line 43 of FORM 1040 and line 27 of FORM 1040A. Please look at your most recent tax
form before completing the following.
****Taxable
Income:
______________
Number of exemptions claimed:
______________
Did you file:
( ) Married, filing jointly
( ) Married, filing separate returns
( ) Single or Head of Household
**Please include a copy of last year's (2009) income tax return with application**
B. IF YOU DID NOT FILE INCOME TAX FORMS LAST YEAR - please complete the following.
Estimated annual income: $______________
Source(s) of this income:__________________
Number of dependents in family:____________
__________________
I certify that the above financial statement is accurate to the best of my knowledge.
_________________
Date
_________________________________________________
Signature of Parent/Guardian
II. First Generation Eligibility
Educational status of natural/adoptive parents who are living in your home (check all that apply):
Mother: ____ years in high school
___ high school diploma
___ GED
___ 2-yr. College diploma
___ 4 yr. College diploma (BS/BA)
Degrees beyond a BS or certifications: _____________________________
Father: ____ years in high school
___ high school diploma
___ GED
___ 2-yr. College diploma
___ 4 yr. College diploma (BS/BA)
Degrees beyond a BS or certifications: _____________________________
Please list the names of the people who live in your household:
Name
Relation to student
1. ___________________________
______________________________
2. ___________________________
______________________________
3. ___________________________
______________________________
4. ___________________________
______________________________
I certify that the above educational information is accurate.
_________________
Date
_________________________________________________
Signature of Parent/Guardian
HIGH SCHOOL SCHEDULE
NAME______________________________________________________________________DATE______________________________
First
Middle
Last
HIGH SCHOOL_____________________________________________________________GRADE______________________________
Please include both semesters of the 2010-2011 school year.
Semester
Period
Class
Instructor
What time does your lunch period begin? 1st semester_________ 2nd semester_______
Extracurricular activities: (church, sports, etc.)
Activity
Days
Time
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Do you have a job? ________________ If so, where do you work?____________________________________
What is your work schedule?__________
Mon.
__________
Tues.
__________
Wed.
__________
Thur.
__________
Fri.
__________
Sat.
__________
Sun.
In what areas can Upward Bound help you? (Check all that apply)
___ Time Management
___ Reading skills
___ Writing skills
___ Choose a career
___ Build my self-esteem & confidence
___ Explore ways to pay for college
___ Study skills or improving study habits
___ Visit other college campuses
___ ACT/SAT prep
___ Improving my grades
___ Math skills
___ Verbal skills
___ Prepare for tests
___ Meet new people
___ Learn more about other cultures
___ Develop new interests
___ Personal development
___ Other _________________________
Information Release
I hereby authorize my high school officials to release my transcript, TCAP scores, Gateway scores, and
any other pertinent school records to the ETSU Upward Bound Program. I understand and agree that all
information furnished in this application is correct to the best of my knowledge. Also, I understand that all
information will be kept confidential.
_____________
________________________________________
Date
Signature of Student
______________________________________
Signature of Parent/Guardian
Parental Consent and Release
I hereby grant permission for my child, ________________________ (name of student), to participate in
the East Tennessee State University Upward Bound program, which may include but not limited to field trips,
tutorial sessions, living in residential halls, end of summer trip, and physical activities. I also understand and
acknowledge that transportation for field trips, academic sessions, conferences, and other activities will be by bus,
van, train, airplane, or private car. Activities may include swimming, bowling, miniature golf, basketball,
volleyball, and other activities. In consideration of the activities provided to my child, I hereby release East
Tennessee State University, the ETSU Upward Bound Program, and their employees from any claims of injury or
damages arising out of my child’s participation. I accept responsibility for my child’s conduct while participating
in the Upward Bound Program, and I hereby release the East Tennessee State University and the ETSU Upward
Bound Program from injuries or damages resulting from my child not following and adhering to the rules and
policies of the program.
_____________
Date
________________________________________
Signature of Student
______________________________________
Signature of Parent/Guardian
Upward Bound Explanation of Activities
Each year while your student is a participant in the ETSU Upward Bound program, we provide various
activities for students to further their academic success. These activities include:
1) Weekly School Visits – Each week staff members from the ETSU Upward Bound program visit our
fourteen target high schools to speak with our students. These visits occur during the student’s lunch period
allowing them to meet with us without missing class. These visits typically take 5 – 10 minutes in which they
receive our Community Scoop – a weekly updated agenda with information about the program and upcoming
dates. The Upward Bound staff also discusses with our students their academic successes and needs. These
weekly check-ins are the primary way we communicate information to our students; thus, consistent attendance is
critical.
2) Monday Night Sessions – One Monday per month the ETSU Upward Bound program hosts an
evening meeting at ETSU for all of our students. Transportation will be provided from the area high schools
to/from ETSU. Dinner will also be provided to our students during these sessions. Students will be engaging in
various classes and seminars that help them prepare for academic success and personal growth.
3) Academic Year Cultural Trip – Each year we provide our students with an opportunity to explore
different activities in the Eastern Tennessee, Western North Carolina, Southwestern Virginia area. This one day
trip will be provided at no cost to the students. Transportation to these events will be provided from a designated
location. Meals will also be provided. These activities could include Barter Theatre, Biltmore Estates, various
college and community theatres, or college campus visits and tours.
4) Six Week Summer Residential Program – Every summer our students are invited to live on the
ETSU Campus for a five weeks residential program. Students will be on campus Sunday evenings through Friday
afternoons taking various academic and enrichment classes to help prepare them for their next year of high school.
Students will be living in two residential halls on campus designated only for the Upward Bound students and
staff. Students will be supervised 24 hrs a day while they are on campus. Upward Bound will not be providing
transportation to/from the area high schools to ETSU, but will be providing transportation to various weekly
activities. At the end of our five week residential program, students will have the opportunity to participate in our
sixth week summer trip. Each year, during the sixth week, we visit a new city for a 3-4 day trip. In previous years
these cities included Chicago (IL), Washington (DC), Atlanta (GA), Charleston (SC), Cincinnati (OH), and
Gettysburg/Hershey/Lancaster County (PA). All of these activities (including summer trip transportation, food,
housing, and admission tickets) are provided at no cost to the students or their families.
The ETSU Upward Bound program believes that students who actively participate in these activities will
enhance themselves academically and ultimately better prepare themselves for college success. While we
recognize and desire for students to participate in a wide range of activities in their schools and communities,
participation in the above mentioned activities are required for students to remain in the program. The ETSU
Upward Bound program, within reason, will try to accommodate students unique situations that may prevent them
from full participation in every event (for example there have been numerous students who check out early during
the summer residential program to attend practice for athletics, band, etc).
By signing below students agree to participate in the various activities mentioned above. Furthermore,
parental/guardian signature below also states that you support your student participating in the various activities
offered by the ETSU Upward Bound program. If you have any questions about any activities, please do not
hesitate to contact the Upward Bound office at 423.439.5619.
_____________
Date
________________________________________
Signature of Student
______________________________________
Signature of Parent/Guardian
UPWARD BOUND TEACHER RECOMMENDATION FORM
Instructions: Please complete this form and return to the student in a sealed envelope.
Name of student:_____________________________________________________Grade:___________
Name of teacher completing recommendation form:
_______________________________________________________________________________
To what extent do you know this student?
How could this student benefit from Upward Bound? (Example: Academically, socially and/or personally)
Please describe the student’s strengths and weaknesses.
APPLICATION CHECKLIST
Please include the following information with your application
1) ____the Upward Bound Application,
2) ____a copy of your family's tax return from last year (if applicable),
3) ____Teacher Recommendation Form
Application Submission
Please note incomplete applications will not be accepted
Due Date: _________________________
Submit To: _________________________
The Selection Process
Upon receiving your application, the Upward Bound Staff will determine your eligibility for the program. The
Upward Bound Staff will then interview all eligible applicants at their school. After interviewing all applicants, the
Upward Bound Staff will accept chosen students into the program. Students who are not chosen will be put on a
waiting list.