Our application for new members is open for the 2024-2025 school year. Please fill out each section and use your phone or email to authenticate the form and submit.

 

 

 
Student Information:
Complete First Name *
Last Name *
Date of Birth *
Address 1 *
Address 2
City *
State *
Zip *
Cell Phone Number
Home Phone (optional)
Email *
Age *
Citizenship *
Social Security Number
Race/Ethnicity *
Which languages do you speak?
What adult-size T-shirt do you wear?
Academic Information:
High School *
Current Grade *
What is your online gradebook's username? *
What is your online gradebook's password? *
Do you have an IEP?
If yes, who is your case worker?
Household Information:
1st Parent/Guardian: Name *
1st Parent/Guardian: Phone *
1st Parent/Guardian: Email *
1st Parent/Guardian: Relationship to student *
1st Parent/Guardian: Highest Education *
2nd Parent/Guardian: Name
2nd Parent/Guardian: Phone
2nd Parent/Guardian: Email
2nd Parent/Guardian: Relationship to student
2nd Parent/Guardian: Highest Education *
How many people live in the household, including the student? *
What was the whole household's taxable income last year? *
Check this box to certify the income provided is accurate
Or, upload the household's most recent tax return
Do you request documents to be provided in another language, or for us to provide interpreter services?
If yes, which language?

Release of Records

The personal information provided in this Upward Bound application is sent to the federal government, specifically the Department of Education. Your information is protected by the Family Educational Rights and Privacy Act. Nobody may see the information unless they work with Upward Bound or are specifically authorized to do so. We must collect personal information to determine eligibility for participation in the program, and this information helps Upward Bound and the Department of Education measure the outcomes of the program.

For the duration my child is enrolled with Upward Bound, and for six years after they graduate high school, I authorize the release of all following information to the Upward Bound program at the College of Saint Benedict & Saint John’s University:

  • Transcripts and report cards from the student’s high school
  •  Standardized test scores, including ACT results
  • School attendance records
  • FAFSA application and Financial Aid award letters
  • WIOA, TANF, and Social Security verification
  • Free/reduced lunch verification
  • National Student Clearinghouse database information

 

Program Agreements

Upward Bound at CSB & SJU has federally-mandated goals for programmatic outcomes. This means Upward Bound and any students who join the program are aiming for the following:

  1. Student GPA: Students must have a 2.5 GPA by the end of each academic year
  2. State Exams: Students must score “proficient” or “exceeding” in MCAs
  3. Continual Enrollment: Students must advance to the next grade level (or graduate) each year
  4. Academic Rigor: Students must follow Program Advisor’s guidance regarding which classes to take in high school, in order to graduate with a rigorous course of study
  5. College Enrollment: Students must start college immediately following high school graduation
  6. College Success: Students must finish their college degree within 6 years of starting it

While not every goal will be met by every student, we must all anchor ourselves to them. To meet these goals, Upward Bound offers the following services, and expects student participation:

  • Weekly after-school tutoring at your high school, provided by current college students to support you for your academic and cultural readiness for college
  • Monthly Saturday events at various locations, typically focused on cultural experiences, career exploration, and social/emotional learning
  • Monthly in-school advising appointments, typically focused on current academics or college preparation activities
  • 6-week Summer Program, where you’re immersed in the college experience: academic classes, career exploration workshops, camp activities and games, cultural events, service learning, and group activities

Additional guidelines for students in support of our shared goals:

  • Attend school and your scheduled classes regularly
  • Stay engaged with Upward Bound’s activities, events, 1:1 meetings, and group activities
  • Follow through on college-readiness tasks like admission applications, completing the FAFSA, taking the ACT, applying for scholarships, accepting admission offers, and enrolling in courses
  • Avoid alcohol, tobacco, abusive substances, firearms, weapons, and bullying behavior

Students and their parents/guardians agree to follow the guidelines above. Parents also commit to providing transportation to and from their child’s high school for programming. If the student’s personal goals deviate from Upward Bound’s goals, or if their consistent behaviors would prevent them from reaching these goals, Upward Bound staff will initiate Parent Conferences and may pursue the student’s removal from the program.

Signatures

I hereby certify that all of the information provided in this application is true and accurate. I agree to the terms of the Release of Records and Program Agreements.

I understand students must be a US Citizen, National or Permanent Resident to qualify for Upward Bound (HEOA 645.3). Admission into the Upward Bound program at CSB & SJU is open to those who meet the eligibility criteria, regardless of gender, race, national origin, color, age, religion, or disability. No person shall be subjected to any discrimination prohibited by the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1972, the Americans with Disabilities Act, and any other applicable laws.

 
Student Signature *
Please select a signature verification type.
Parent/Guardian Signature *
Please select a signature verification type.