Thank you for your interest in the TRIO Upward Bound Math and Science (UBMS) program. To be eligible for the program, a student must currently be in the 9th, 10th, 11th, or 12th grade attending Central, Colbert County, Haleyville, Lexington, Muscle Shoals, Rogers, Sheffield, Vina, or Wilson high school.

Upward Bound is an academic program that requires a commitment from the student and cooperation from parents. A student joining Upward Bound Math and Science must actively participate in our after-school program during the academic year and are highly encouraged to participate in our six-week summer program. Once accepted, we expect students to continue with the program for the duration of their high school career.

Upward Bound is a federally-funded program; there is no fee charged for participation. Students receive a stipend based on attendance. We offer ACT prep, academic and career advising, college planning and visits, grant and scholarship information, field trips, STEM camp, tutoring/enrichment activities, and many other opportunities.

Please contact us if you have any questions at 256-331-5495.


Student Information:
Last Name *
First Name *
Middle Name
Date of Birth *
Address 1 *
Address 2
City *
State *
Zip *
Home Phone
Cell Phone Number *
Email *
Social Security Number *
Gender *
Ethnicity *
Race (If not Latino, check one) *
Current Grade Level *
Current School Attending *
Seeking Advanced/Honors Diploma? *
Do you plan to attend college? *
Are you now receiving or have received services from another TRiO program? (Talent Search, Upward Bound) *

Family Information:
Who does student reside with? *
Contact 1 Name *
Contact 1 Cell Phone
Does this parent have a 4 year college degree? *
Contact 2 Name *
Contact 2 Cell Phone
Does this parent have a 4 year college degree? *
How many people in household? *
Family Income (taxable income, not gross) If you filed in 2021: 1040 Line 15 *
If you did not file taxes in 2021, what is your estimated income?
Is the applicant a ward of the court?

Please write a short essay explaining your interest in the Program, educational goals, career goals, family history and how you would benefit from this Program.

*I give permission for my son/daughter to be interviewed, photographed or videotaped by Upward Bound Math and Science for use on radio, TV, in printed news media, or in program promotional materials and documentation.

*The UBMS project has my permission to conduct all necessary assessments for my son/daughter. I understand these tests may include academic achievement and vocational-interest inventories. I further understand that any information obtained from this testing will not be released to any other organization, other than those mentioned in the Statement of Confidentiality section, without my permission. 

I am the parent/guardian financially supporting the applicant and declare that to the best of my knowledge and belief, the information is true, correct, and complete.

STUDENT & PARENT CONTRACT:   In order for us to serve you with a strong academic, cultural, and collegiate program, we must have sincere commitment from you.  In failure to abide to these agreements could result in being released from the Upward Bound Math and Science Program. Please carefully review the following:

  I understand that during my participation in Upward Bound Math and Science (UBMS):

1.  My goal will be to complete high school and pursue post-secondary education.

2.  I commit to attending all UBMS meetings, two hour weekly tutoring sessions, and the 6-week summer program.

3.  I commit to maintaining a minimum of 2.5 GPA or higher.

4.  I commit to turning in forms when due and being on time to tutoring, classes, trips, and seminars.

5.  I commit to completing all college admission forms during 12th grade year and applying for federal financial assistance and scholarships.

6.  I will abide by all rules and regulations of UBMS and Northwest-Shoals Community College.

7.  I commit to show positive attitudes and behaviors while participating in UBMS activities and to commit to active participation in the UBMS Program.

 In addition to the application data given here, information from other sources will need to be obtained to sufficiently meet the academic needs of students and the reporting requirements of the U.S. Department of Education.  Information from high schools, colleges, testing institutions, and other agencies will be requested on behalf of UBMS participants. 

Signing below authorizes UBMS:

  1. To request a copy of middle/high school and/or college transcripts and test scores from high school
  2. To request a copy of SAT and/or ACT test scores
  3. To use a Social Security Number to request copies of financial aid applications, transcripts, college enrollment status and awards from the federal & state funding agencies, post-secondary institutions, and National Student Clearinghouse
  4. To communicate with representatives from agencies, post-secondary institutions on behalf of a participant

 I hereby authorize Upward Bound Math and Science to contact and request information from, as well as to share information with, the above mentioned parties.  I give my son/daughter permission to participate in Upward Bound Math and Science activities and field trips.  Our signatures below indicate our commitment to the Upward Bound Math and Science Student and Parent Contract.

Sign and Submit:
Parent/Guardian Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:
 

To the best of my knowledge, all the information I have provided in this application is true.

STATEMENT OF CONFIDENTIALITY: TO PARENT OR LEGAL GUARDIAN: The personal information requested by the Upward Bound Math & Science project is required by the U. S. Department of Education. The information is protected by the Privacy Act. No one may see the information unless they work with or for the Upward Bound Math & Science project, another TRIO program associated with Northwest-Shoals Community College, or are specifically authorized by you, the parent, to have access to the information submitted. The information collected is necessary to determine if your child is eligible to participate in the Upward Bound Math & Science project and aids the U. S. Department of Education in measuring his/her success. The U.S. Department of Education has the authority to gather such information. (20 USC 1232a). Your child will not be eligible for any services from the Upward Bound Math & Science project unless all information is complete.
Applicant Signature *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number:
 

Upward Bound Math & Science is a 100 % Federally Funded Project by the U.S. Department of Education in the amount of $297,601. It is the policy of the ACCS Board of Trustees or Alabama Community College System and Northwest-Shoals Community College, a postsecondary institution under its control, that no person shall, on the grounds of race, color, disability, sex, religion, creed, national origin, or age, be excluded from participation in, be denied the benefit of, or be subjected to discrimination under any program, activity, or employment.