I/We certify that all information provided on this TRIO Upward Bound (hereafter referred to as “UB”) application is true and correct to the best of my/our knowledge.
I/We understand the completion of this application does not guarantee acceptance into the TRIO UB program.
I/We understand the information provided on this application will be held in confidence by the TRIO UB program according to the Federal Privacy Act, Family Educational Rights and Privacy Act (FERPA), and as allowed for by the UB Record Disclosure consent form on file.
I/We understand signature below indicates UB participant will follow the UB code of conduct, UB academic agreement, current school rules and regulations in place at my local school as stated in the student handbook as well as the rules and regulations of the colleges, universities & places we visit (strictly enforced).
I/We authorize TRIO UB staff to communicate with teachers, counselors, school staff and school and other administrators in an effort to obtain and exchange information pertinent to providing recruitment into the program and TRIO UB services.
I/We authorize the release and exchange of student financial aid information, post-secondary enrollment information, and transcripts from, but not limited to, colleges, state and federal government agencies to the TRIO UB program.
I/We grant permission for my child to attend TRIO UB field trips.
I/We authorize TRIO UB to seek medical attention for UB participant if needed.
I/We understand that if accommodation for a disability is needed to participate in UB, or any of its scheduled activities, I must contact Upward Bound at (509) 793-7678 with ample notice prior to the activity.
I/We release TRIO Upward Bound and WSU of any and all liability.
I/We understand that TRIO UB, WSU, as well as the Washington State TRIO association, Regional TRIO association of which this UB program is a part, and the Council for Opportunities in Education, Moses Lake High School, Vanguard Academy and Warden High School have full and absolute permission and all rights to copyright, publish, display, and use for any legal purpose all photos, videos, and/or voice recordings together with descriptive text or statements, in which I or my child/children and/or property appear from this date forward unless we notify WSU-TC CB TRIO UB in writing.
I understand, if accepted, I will fully participate throughout high school, and until college graduation, including academic year and summer activities. I also understand that if I do not, I may be dismissed from the program.