Application

Thank you for your interest in the TRIO Upward Bound Program at Cosumnes River College. The Upward Bound Program is an academic resource and college preparatory program focused on assisting high school students to develop academic skills and cultivate motivation allowing them to make informed decisions regarding post-secondary education.

The program serves students from families who meet federal income criteria and are potential first-generation college bound students (neither parents/guardians have a 4-year baccalaureate degree). The program is 100% federally funded by the U.S. Department of Education and all services are FREE to participants.

All information you provide in the application will be used to determine your eligibility for the TRIO Upward Bound Program and will be kept under strict privacy.

Student Information

First Name *

Middle Name

Last Name *

Preferred Name

School *

Student ID *

Address 1 (Street Number and Name) *

City and State

Zip Code *

Providing us with your personal email address is essential for you to return to your saved application, and complete all permission slips throughout your participation with Upward Bound. Please verify that it is correct before saving your application - an email is sent to the provided email with a link to create a password with our database. If you put an email that does not belong to you, the owner of that email will be allowed to create a password and access the personal information that you provided in your application.

Email *

Home Phone *

Cell Phone *

Date of Birth *

What sex were you assigned at birth? *

Which gender identity do you most identify?

Preferred pronouns (i.e: she/her/hers or he/his/him or they/them, etc.)

Ethnicity *

Graduation Date *

Grade *

Do you participate in other pre-college programs: *

Income Source

Parent Information

Taxable Income *

Family *

IF YOUR PARENT(S) FILED TAXES YOU MUST UPLOAD A SIGNED COPY OF THE 2022 1040 TAX FORM IN ORDER TO VERIFY ELIGIBILITY FOR TRIO UPWARD BOUND PROGRAM. WE MUST BE ABLE TO SEE LINE 15, "TAXABLE INCOME."

PLEASE UPLOAD YOUR MOST RECENT UNOFFICIAL SCHOOL TRANSCRIPT FROM SYNERGY. THIS CAN BE FOUND UNDER “COURSE HISTORY.”

Family Size *

Name of Parent/Guardian 1

Relationship with Parent/Guardian 1

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 Email Address

Can UB send your Parent/Guardian 1 text messages/email?

Parent/Guardian 1's Highest Education Level Completed:

Name of Parent/Guardian 2

Relationship with Parent/Guardian 2

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Email Address

Can UB send your Parent/Guardian 2 text messages/email?

Parent/Guardian 2's Highest Education Level Completed:

Spend some time with this section. We are interested in getting to know who you are. Please type your answers with minimum 100 words per question.

Please introduce yourself including your family background, educational, and career goals.

Reasons why you would like to join CRC TRIO Upward Bound and what do you expect to gain by joining the program.

How will being a part of TRIO Upward Bound help you reach your personal and academic goals?

Anything else that may be helpful in giving us a more complete picture of you (participation in extracurricular activities, community service, working, etc.).

I/We hereby certify that the information reported in this application packet is true, complete and accurate to the best of my/our knowledge. I/We understand that a false statement or misrepresentation will make the applicant ineligible for Cosumnes River College TRIO Upward Bound.

Student Signature

Parent Signature

By selecting 'I Agree' and submitting this form, I certify that the above information is correct to the best of my knowledge. I understand that this information is being provided as a matter of record; it will be kept strictly confidential. I authorize this program to obtain copies of my transcripts, test scores, financial aid awards, and other materials necessary for participation in the program. I will also grant permission for my photograph, photographic image, and/or video recorded image to be published in materials such as newsletters, annual reports, recruiting presentations, web pages, e-Profiles, etc., and release this program from any liabilities.

I Agree