TRiO Upward Bound Application

Thank you for your interest in the TRiO Upward Bound college prep program! Please complete the application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes, and then return to submit your application. 

Upon receipt, UB staff will follow up to determine eligibility, forward paperwork, solicit documentation, and schedule an orientation. If you have any questions, please call our office at 602-305-5676. We are here to help!

Student Information
First Name *
Last Name *
Middle Name
Contact 1 Address *
Contact 1 Address 2
City *
State *
Zip Code *
Student Phone Number *
Email Address *
Gender *
DOB *
Race/Ethnicity (check all that apply):
American Indian or Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
Hispanic
U.S. Citizen or Permanent Resident *
If you answered yes above as a permanent resident, provide A# (Alien Registration Number)
Have either parent(s) received a bachelor's degree?
Academic Information
Entry Grade Level *
Entry GPA *
If you do not have a GPA, please enter 0.000.
High School *
High School Guidance Counselor Name *
Do you have a disability requiring accommodations? *
Have you ever participated in any of the following TRiO programs or other college preparatory programs? *
Please select the area of career fields/interest you are most interested in. *
Parent/Guardian Information
Parent Phone Number *
With whom do you live with? *
Is English spoken as the primary language in your home? *
If you answered no above, please specify the primary language spoken at home.
How many people are in your family including yourself? *
What is your family's taxable income? *
Taxable income is used by the U.S. Department of Education as a qualifier for this program. Taxable income can be found on your family's most recent 1040 federal tax form- line 11b.
Review and Signatures/Other
Referral Source
How do you prefer to receive additional forms? *

STUDENT RESPONSIBILITY

My signature below indicates my understanding and agreement to the following:

  • All of the above information is true and correct to the best of my knowledge.
  • I am committed to achieving a four-year degree.
  • I agree to actively participate in SMCC’s Upward Bound program which includes: participating in tutoring sessions, weekly lunch meetings, enrichment sessions, field trips/tours, Saturday Academies, and attend the 6-week summer and residential program.
  • I understand that difficulty in making academic progress and not meeting the program requirements may result in possible probation/dismissal from the Upward Bound Program.
  • I give permission to have my name and/or picture published in any program marketing materials without any compensation of any kind or restriction of its use.
  • I authorize Upward Bound to have access to my school (academic/financial) records while in the program with respect to confidentially for program purposes only.
  • I understand that the program data collected is used for tracking and research purposes.
Sign here. *
Please select a signature verification type.

Maricopa County Community College District (MCCCD) is an EEO/AA institution and an equal opportunity employer of protected veterans and individuals with disabilities.  All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of the college.

The Maricopa Community Colleges do not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities.  For Title IX/504 Concerns, call the following number to reach the appointed coordinator:  (480) 731-8499.  For additional information, as well as a listing of all coordinators within the Maricopa College system, visit the following weblink:  https://distict.maricopa.edu/consumer-information/non-discrimination-statements.