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2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
2010 Upward Bound Application[1]
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2010 Upward Bound Application[1]

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  • 1. UPWARD BOUND 2010 Application TRIO programs, funded under Title IV of the Higher Education Act of 1965, help students overcome social, academic and cultural barriers to higher education. The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 2. Dear Parent: Thank you for considering Upward Bound for your student! Let us take a moment to fill you in on our program, the process involved in your student’s acceptance, and the commitment required of you and your student. Upward Bound is a federally funded program, sponsored by the Department of Education. The Upward Bound program based at Rich Mountain Community College in Mena works with approximately sixty-five 9-12 grade students in the high schools from Polk, Montgomery, and Scott counties. We are a unique and elite group. The Upward Bound program at Rich Mountain Community College assists selected participants in grades 9 through 12 to complete secondary school, enroll in post-secondary school, and complete a bachelor’s degree by providing intense academic, career, personal, and financial advising; academic instruction in language arts, mathematics, foreign language and science; tutorial services; college credit courses after their junior year of high school at Rich Mountain Community College; college credit courses after their high school graduation at Rich Mountain Community College; and cultural and recreational activities throughout the year to increase program, staff, and participant bonding. The UB program provides professional development opportunities/activities to strengthen/supplement the professional skills of the staff. Who are we looking for? Upward Bound participants must meet family income guidelines as set forth by the federal government. Additionally, neither parent may possess a four-year college degree. Our focus is to target, select, and help those students in our area that have the desire and potential to succeed in college actually reach their goals. These students do not have to be the top students in their class, merely solid students with a certain academic, social and/or cultural need. If selected for this program, your student will be provided with all the services listed on the adjoining pages, and upon entrance into college, should have completed about of 12 college hours that will transfer to any college in Arkansas. “UBers” do have to make quite a commitment to the program. They meet at least one hour a week after school with an academic tutor, receiving academic support; another day with their designated UB Coordinator, receiving support and enrichment in a variety of activities; and two Saturdays a month, where we include ACT preparation classes, campus tours, etc. During the summer, all UBers are required to attend a six-week academic component, which is highly rewarding. As long as they meet the requirements of the program, they remain in Upward Bound until graduation. The selection process is relatively painless. After we collect all applications, we will screen the applications for those qualified based upon family income and parental education guidelines. Therefore, we will have to ask you for some financial information. It will be kept completely confidential. Generally, if the applicant qualifies, they are granted an interview that takes place at a nearby high school. This is informal. (They don’t need to feel nervous.) We will interview the applicant and parent. The whole process takes about thirty minutes. After we have completed the interview process, we will make the final selections. Those selected will start at the end of October or early November. Please keep in mind that we are only able to take in about 15 students per year from all nine schools, so if your student is not selected, it is not necessarily a reflection on their intelligence or abilities. They are also welcome to reapply next year. We hope that this letter answers a few of the questions that parents often ask. If you have any additional questions, feel free to call (479) 394-7622, ext. 1633 or ext. 1632. Sincerely, Rodney Rowland & Jimmy Rackley The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 3. Instructions and Information The Student Information section of the application must be completed by the applicant, and the Parent/Guardian section must be completed by the applicant’s parent/guardian(s). If you have questions, please talk to your counselor or call the Upward Bound office at (479) 394-7622, Rodney Rowland (ext. 1633), or Jimmy Rackley (ext. 1632). To complete your application, please follow the checklist below and turn the packet in to your counselor or mail to: Rich Mountain Community College Upward Bound 1100 College Drive Mena, AR 71953 The application deadline for 2010 is September 30. Application Checklist Return the items mentioned below in bold type to your high school counselor or to the UB office. (1) Application o Applicant completes Student Information section of application (the teacher reference blanks must all be complete) o Parents/Guardians complete Parent/Guardian section of application o Student and parent sign the release form o Student completes the essay/autobiography page (can be typed on another sheet or handwritten) o Give your math and science teachers and counselor the referral forms. Instruct them to return the completed forms to the counselor. We will pick up the recommendations from your counselor. Do not send them with your application! (2) Transcript o Obtain an official transcript with test scores from your counselor. What’s Next? 1. After your application is submitted, we will review your application with all the others. 2. If you qualify, we will mail you or call you to set up an interview with you and your parent(s). 3. After we have completed all interviews, we will make the final selections. 4. You will receive a letter from us whether or not you have been accepted. 5. If you are accepted- great! Welcome to UB! If not, we will send you a letter explaining why you were not accepted. The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 4. Student Information (Please Print) Name: _______________________________________ Social Security No: ______-_____-_______ Last First Middle (Required) Name Preferred: _____________________ Email: ____________________ D.O.B ___/___/_____ Address: ____________________________ Phone: ( ) -______ Cell: ______________ City: ________________________ State: ___ Zip: _______ High School: ______________________ Grade: 9 10 11 Gender: ___ Male ___Female Ethnic Origin: ___ African American/Black Are you: ___ a U.S. citizen ___ Asian ___ an eligible non-citizen (please provide a ___ Caucasian copy of immigration documentation) ___ Hispanic/Latin American ___ Other ___ Native American ___ Other: ____________________ What is the primary language(s) spoken in your home? ___ English ___ English/Spanish ___ English ___Other: _______________ How did you hear about this program? ___ Counselor ___ Teacher ___ UB Student ___ Other What do you plan to do after you graduate high school? (check all that apply) ___ Attend a four-year college ___ Attend a community college for a one or two year degree ___ Enroll in a technical college program ___ Enlist in the military ___ Get a job ___ Attend a trade school ___ Other (please specify) ______________________ In what areas can Upward Bound help you? (check all that apply and rank them in order of importance) ___ Manage my time ___ Improve my grades ___ Prepare for tests ___ Choose a career ___ Build my self-esteem ___ Explore ways to pay for college ___ Visit new places ___ Meet new people ___ Learn about college options ___ Develop new interests ___ Learn about other cultures ___ Study skills ___ Visit college campuses ___ Other _____________________ Please check the courses that you have taken or are currently taken. ___ Algebra I ___ Algebra AB ___ Biology ___ Algebra II ___ Algebra CD ___ Chemistry ___ Geometry ___ Integrated Algebra ___ Other Math or Science (describe) ___ Geometry Investigation ___ Physical Science _____________________________ What obstacles or difficulties do you face that may affect your educational and career plans? ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 5. Please indicate who will submit the recommendation forms for you and which school they are located. ___________________________________________________________________________________ Name of 09-10 English Teacher School ____________________________________________________________________________________ Name of 09-10 Math Teacher School ____________________________________________________________________________________ Name of 09-10 Science Teacher School ____________________________________________________________________________________ Name of Counselor or other Personal Reference School Parent/Guardian Information This section must be completed by the student’s parent/guardian(s). If you have questions, please call the UB office at (479) 243-0739 ext. 1632 or 1633. Confidentiality of Information No one is allowed to see the information you provide unless he/she is an employee of Rich Mountain Community College TRIO programs or otherwise authorized to see this information. All information provided in this section is protected by the Privacy Act and is not specifically reported to the federal government or the U.S. Department of Education. 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 the Upward Bound program. Father/Male Guardian Mother/Female Guardian ______________________________________ ______________________________________ Last First MI Last First MI Highest education level completed: Highest education level completed: ___ Elementary School (K-8) ___ Elementary School (K-8) ___ High School (9-12) ___ High School (9-12) ___ Associate’s Degree ___ Associate’s Degree ___ Bachelor’s Degree or beyond ___ Bachelor’s Degree or beyond Marital Status: ___ Married ___ Divorced ___ Separated ___Unmarried ___ Widowed ___ Other Student primarily lives with _____________________________ Parent/Guardian Name Please complete all blanks. If parents are separated, this should be completed by the parent whom the student lives with, or by the parent/guardian providing at least 50% of student’s financial support. Parents’ Occupation: Father: _____________________ Mother: ____________________________ Father’s Work Phone Number: ____________________ Mother’s Work Number: _______________ Parent(s)’ taxable income (see line 43 of 2009 Form 1040, line 27 of 2009 1040A or line 6 of 2009 1040EZ)_________________ If income was $0, please explain. _______________________________ Number of people in household: Adults _____ Children _____ I certify by signing below that the above information is correct and that any false or misleading information may result in disqualification of the applicant. _________________________________________ Parent(s)’ Signature The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 6. Information Release Form RICH MOUNTAIN COMMUNITY COLLEGE UPWARD BOUND PROGRAM Permission to Release Information for _________________________________ Student’s Name (Please Print) I authorize Rich Mountain Community College Upward Bound Program and ______________________ High School to release and/or receive copies of my son’s/daughter’s academic records, including, but not limited to transcripts, grade reports, test scores, evaluations, attendance and medical records, disciplinary actions, and other records necessary to for participation in the program. This information may be used for any federal reports of the Upward Bound program. Otherwise, these records will remain confidential and will only be used by the Upward Bound staff. This release is to be effective throughout my high school and college career and will be terminated only upon college graduation or termination from the Upward Bound program. __________________________________ Date: __________________ Student Signature __________________________________ Date: __________________ Parent/Guardian Signature Disclosure of Information. The Program may disclose and/or publicize both the Upward Bound participant's and the parents' identities in connection with academic, promotional or fund raising activities for the program. The parent and the Upward Bound participant, after becoming an undergraduate student at an institution, grant the Upward Bound program permission to reveal his/her academic records in connection with keeping statistical data on the program or in fund raising for or publicizing the program; such use of the Upward Bound participant’s undergraduate academic records shall be limited to circumstances in which the Upward Bound participant's name is not linked with his/her individual grades unless, however, permission is otherwise obtained. _________________________________ Date: __________________ Student Signature _____________________________________________ Date: __________________ Parent/Guardian Signature The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 7. PLEASE NOTE: Completion of this essay is instrumental to the Upward Bound selection process. AUTOBIOGRAPHY (Confidential) On this page, please write an essay of your life history. Be sure to include information- 1. about your family, people or events that have had a significant impact on your life. 2. on your personal, goals, hopes and dreams. 3. about your career interests 4. on why you want to be a part of the Upward Bound Program Include hobbies, likes, dislikes, and any other information that will help us to get to know you better. Please feel free to write on the back or on an additional piece of paper. All information will be held in the strictest confidence. When finished, please submit this with your completed application. The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 8. RICH MOUNTAIN COMMUNITY COLLEGE UPWARD BOUND ENGLISH TEACHER REFERENCE FORM STUDENT___________________________________________DATE ____________________ SCHOOL______________________________________GRADE/COURSE ________________ TEACHER’S NAME ____________________________________________________________ Teacher: The applicant above has applied to the RMCC Upward Bound program. Please evaluate this student as objectively as possible. All information will be held in the strictest confidence. After completion, please return this form to the school counselor as soon as possible. Do not return to the student. If you have questions, please call Rodney Rowland at (479) 243-0739 ext. 1633 or Jimmy Rackley ext. 1632. Thank you for your assistance! YES NO ___ ___ 1. Do you feel that this student had/has an adequate background for this class? ___ ___ 2. Did/Does this student ask for additional help? ___ ___ 3. Did/Does this student take adequate notes? ___ ___ 4. Did/Does this student have a positive attitude in this class? ___ ___ 5. Did/Does this student complete and turn in homework assignments consistently? ___ ___ 6. Do you feel that this student knows how to study? ___ ___ 7. Did/Does this student demonstrate punctuality? ___ ___ 8. Did/Does this student cooperate with school officials? ___ ___ 9. Has this student expressed an interest in post-secondary education? ___ ___ 10. Do you feel that this student has acceptable social skills? ___ ___ 11. Do you feel that this student has a need for more cultural awareness? ___ ___ 12. To the best of your knowledge, does this student have any illegal habits (underage tobacco use, alcohol, drugs, et.)? ___ ___ 13. Do you feel that this student has the potential to succeed in college? 14. What services would you recommend for this student to prepare him/her for high school and/or college?________________________________________________________________________ 15. How would you rank this student? Circle the ranking. Superior=4 pts, Average=2 pts, Poor=0 pts. Please comment._________________________________________________________________ _________________________________________________________________________________ The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 9. Rich Mountain Community College- Upward Bound Math Teacher Reference Form STUDENT:__________________________________________DATE ______________ SCHOOL_______________________________GRADE/COURSE ________________ TEACHER’S NAME _____________________________________________________ Teacher: The applicant above has applied to the RMCC Upward Bound program. Please evaluate this student as objectively as possible. All information will be held in the strictest confidence. After completion, please return this form to the school counselor as soon as possible. Do not return to the student. If you have questions, please call Rodney Rowland at (479) 243-0739 ext. 1633 or Jimmy Rackley ext. 1632. Thank you for your assistance! YES NO ___ ___ 1. Do you feel that this student had/has an adequate background for this class? ___ ___ 2. Did/Does this student ask for additional help? ___ ___ 3. Did/Does this student take adequate notes? ___ ___ 4. Did/Does this student have a positive attitude in this class? ___ ___ 5. Did/Does this student complete and turn in homework assignments consistently? ___ ___ 6. Do you feel that this student knows how to study? ___ ___ 7. Did/Does this student demonstrate punctuality? ___ ___ 8. Did/Does this student cooperate with school officials? ___ ___ 9. Has this student expressed an interest in post-secondary education? ___ ___ 10. Do you feel that this student has acceptable social skills? ___ ___ 11. Do you feel that this student has a need for more cultural awareness? ___ ___ 12. To the best of your knowledge, does this student have any illegal habits (underage tobacco use, alcohol, drugs, et.)? ___ ___ 13. Do you feel that this student has the potential to succeed in college? 14. What services would you recommend for this student to prepare him/her for high school and/or college?_______________________________________________________________________ 15. How would you rank this student? Circle the ranking. Superior=4 pts, Average=2 pts, Poor=0 pts. Please comment. ______________________________________________________________________ _____________________________________________________________________________________ The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 10. RICH MOUNTAIN COMMUNITY COLLEGE UPWARD BOUND SCIENCE TEACHER REFERENCE FORM STUDENT___________________________________________DATE ______________ SCHOOL________________________________GRADE/COURSE ________________ TEACHER’S NAME ______________________________________________________ Teacher: The applicant above has applied to the RMCC Upward Bound program. Please evaluate this student as objectively as possible. All information will be held in the strictest confidence. After completion, please return this form to the school counselor as soon as possible. Do not return to the student. If you have questions, please call Rodney Rowland at (479) 243-0739 ext. 1633 or Jimmy Rackley ext. 1632. Thank you for your assistance! YES NO ___ ___ 1. Do you feel that this student had/has an adequate background for this class? ___ ___ 2. Did/Does this student ask for additional help? ___ ___ 3. Did/Does this student take adequate notes? ___ ___ 4. Did/Does this student have a positive attitude in this class? ___ ___ 5. Did/Does this student complete and turn in homework assignments consistently? ___ ___ 6. Do you feel that this student knows how to study? ___ ___ 7. Did/Does this student demonstrate punctuality? ___ ___ 8. Did/Does this student cooperate with school officials? ___ ___ 9. Has this student expressed an interest in post-secondary education? ___ ___ 10. Do you feel that this student has acceptable social skills? ___ ___ 11. Do you feel that this student has a need for more cultural awareness? ___ ___ 12. To the best of your knowledge, does this student have any illegal habits? (underage tobacco use, alcohol, drugs, et.)? ___ ___ 13. Do you feel that this student has the potential to succeed in college? 14. What services would you recommend for this student to prepare him/her for high school and/or college?_______________________________________________________________________ 15. How would you rank this student? Circle the ranking. Superior=4 pts, Average=2 pts, Poor=0 pts. Please comment. ______________________________________________________________________ _____________________________________________________________________________________ The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.
  • 11. Upward Bound Counselor Referral Form Note: Please attach a current transcript and a copy of current Benchmarks, End of Course, Stanford and/or ACT testing reports. Student Date School Grade Counselor’s Name I highly recommend this person for the Upward Bound Program (Superior) I recommend this person for the Upward Bound Program (Average) I do not recommend this person for the Upward Bound Program (Poor) Comments: (please reply as honestly as possible) Signature Date The Upward Bound program at RMCC is funded in total (100%) by federal grant funding from the U.S. Department of Education, with an annual budget of $339,381. For questions and other information, please contact Brenda Miner, Director of TRIO Secondary Programs at 479-243-0739, extension 1642.

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