Complete this application if you are interested in participating in DCTC Upward Bound. Some information will need to be completed by your parent(s)/guardian(s) and requires their signature(s). The application will take 15-30 minutes to complete and must be completed in a single session.

If you have questions about anything on the application, email UpwardBound@dctc.edu or text* 833-557-1200.

*Note: this is a text only number and cannot receive calls.


BEFORE YOU BEGIN:

  • You will need to enter your family's taxable income from your most recent tax returns (form 1040). This can be found on line 15 of your 2020 form 1040.
  • If your parent(s)/guardian(s) did not file taxes, you will need to enter the amount of taxable income earned in the last tax year.
  • We need information about your birth parents or legal guardians to determine if you are eligible to participate in our program, even if you live with someone else.
  • You will need to enter the names of 2 adults not related to you who are willing to provide a reference for you. At least one of these people must be a current or former teacher who is able to speak to your academic performance as a student. You should ask your references for their permission to use them as a reference before you submit their information on this form.

Please complete all required fields carefully and completely. Incomplete applications (incomplete phone numbers/email addresses/etc.) will not be considered.


STUDENT SECTION

The fields in this section should be completed by the student who is applying for admission to DCTC Upward Bound.

CONTACT INFORMATION

Please enter the information you would like us to use to contact you. Email is our primary mode of communication, so please enter the email address you check most frequently.

Legal First Name *
Legal Middle Name
Legal Last Name *
Suffix
Preferred Name - what you would like us to call you
Date of Birth (MM/DD/YYY) *
Home Address *
Apartment/Unit/Lot Number
City *
State *
Zip Code *
Cell Phone Number *
Check this box if you do NOT want to receive text messages from Upward Bound.
Email Address (use the email you check most frequently) *

HIGH SCHOOL INFORMATION

Complete the information below about your high school.

High school you attend (or will be attending) *
School you currently attend (if in 8th grade)
Student ID Number *
Current grade in school *
School counselor *
Current GPA *
Have you taken the MCA Reading test in high school? *
Have you taken the MCA Math test in high school? *

PLANS FOR AFTER HIGH SCHOOL

The questions below ask about your current interests and plans for after high school. If you don't know, that's okay! Upward Bound will help you figure out your interests. 

What do you want to do after high school? *
What majors or careers are you considering? *
Are there any colleges you are considering? *

DEMOGRAPHIC INFORMATION

We are required to collect/report on the information below for all Upward Bound participants. The information provided in this section is used only for Federal reporting purposes and plays no role in your selection for admission to the program.

At DCTC Upward Bound, we recognize the importance of creating a culture that respects names and gender pronouns. If a student would like to communicate a name change and/or change in gender pronouns, we invite you to share this change at any point.  Honoring the names and/or pronouns of each other is an expectation of program civility and participation.

 

To learn more about Minnesota State’s 1B.1 Equal Opportunity and Nondiscrimination policy, which includes gender identity and gender expression, please visit:

https://www.minnstate.edu/board/policy/1b01.html

What is your gender identity? *
What pronouns do you use, if any? *

What is your racial identity? Check all that apply.


American Indian or Alaskan Native
Asian
Black or African American
Hispanic
Native Hawaiian or Other Pacific Islander
White
Other race/ethnicity not listed:
Do you identify with any ethnic/cultural groups?
Primary language(s) spoken in your home *
Do any of the following situations apply to you? *
If yes, please explain.

ELIGIBILITY INFORMATION

The questions in this section help us determine if you are eligible to participate in our program. Questions about citizenship refer only to the student, no one else in the family, and are used only for purposes of determining eligibility. Your answers will only be seen by Upward Bound staff.

What is your citizenship status? *
Student's social security number *

SHORT ANSWER QUESTIONS

Please respond to the questions below about your interest in our program.

Why are you interested in joining Upward Bound? *
What are some challenges you think you will face in high school and/or college? How can Upward Bound help you navigate those challenges? *
What do you feel is your greatest need for support? *
Why do you need support in this area and how do you think Upward Bound can help you? *
What extracurricular activities (sports, clubs, etc.) are you involved in? *
What are your hobbies and interests? What do you like to do outside of school? *

We strongly encourage Upward Bound students to participate in other activities outside of Upward Bound. Being involved helps you stay connected to your school and colleges want to see that you were involved in extracurricular activities.

However, we do ask that you still make attending Upward Bound a priority. If you don't attend UB activities, you miss out on the information we share and the benefits of being in the program. Federal grant regulations specify that students need to attend at least 60 days during the academic year and 10 days during the summer program in order to be counted as an active participant in the program.

If you need to be gone for any reason, we ask that you notify your advisor ahead of time and make plans to make up the missed session. 

If you are consistently absent from the program and do not communicate with us about your absences, you may be dismissed.

Upward Bound typically meets twice per week after school and one Saturday per month during the school year. Students are also expected to schedule regular 1:1 meetings with their advisor and homework tutors. 

We also have a 6-week summer program. Classes run Monday-Friday from about 8:30 AM to 3:00 PM and usually start mid-June and run through the end of July.

Students are generally expected to participate year round, and the first summer you are admitted to the program is mandatory.

What is the time commitment for these other activities? How will you be able to manage your time so you can make attending Upward Bound a priority? *

REFERENCES

Please provide the names of two people NOT RELATED TO YOU who are willing to act as a reference for you. We will be emailing them a brief survey to fill out on your behalf. 

By putting someone's name and email address below, you are giving us permission to email them. 

ACADEMIC REFERENCE

Please provide the name and email address of one of your teachers who can speak to your skills as a student.

Name *
Email address *
How do you know this person? *

PERSONAL REFERENCE

Please provide the name and email address of an adult NOT RELATED TO YOU who can speak to your skills outside of the classroom. This can be a teacher, coach, religious leader, supervisor, family friend, etc.

Do NOT use a parent, relative, or friend. 

Name *
Email Address *
How do you know this person? *

By signing your name in the box below, you agree to the following statements:

  • I certify that everything on this application is true to the best of my knowledge. Deliberately providing false information may result in dismissal from the program. 
  • I give Upward Bound permission to email my references. 
  • I will check my email for updates on the status of my Upward Bound application. 
Student Signature *
Please select a signature verification type.
Today's date *

 


PARENT/GUARDIAN SECTION

The questions below should be answered by your parent or legal guardian.

PARENT/LEGAL GUARDIAN #1
First and Last Name *
Relationship to the student *
Relationship to student (if you selected Other)
Street Address *
Apartment/Unit/Lot Number (if applicable)
City *
State *
Zip Code *
Phone Number *
Check if you want to receive copies of text messages we send your student.
Email Address *
Highest level of education completed *

PARENT/LEGAL GUARDIAN #2

Complete the fields below even if you only live with one parent/guardian. Fill out as much information as you are able; if you are unable to answer some questions, type Unknown or N/A  in the fields.

First and Last Name *
Relationship to the student *
Relationship to student (if you selected Other)
Street Address *
Apartment/Unit/Lot Number (if applicable)
City *
State *
Zip Code *
Phone Number *
Check if you want to receive copies of text messages we send your student.
Email Address *
Highest Level of Education Completed *

It is important to us that we are able to communicate with a student's parent(s)/guardian(s), even if they primarily speak a language other than English.

Please let us know if a translator is required for us to contact you and which langauge is needed.

Translator needed? *
If yes, what language?

HOUSEHOLD INCOME

Federal grant regulations require us to collect household taxable income to determine a student's eligibility. Your taxable income is your Adjusted Gross Income minus any deductions.

If you filed 2020 taxes, this is line 15 on Form 1040.

Click here for more information on Federal TRIO income levels.

What is your household taxable income?? *
Including the student, how many people live in your household? *

PARENT/GUARDIAN SIGNATURE(S)

By signing my name in the box below, I certify that all statements I provided on this application are true and correct to the best of my knowledge. I understand that a false statement may disqualify my student for participation in the Upward Bound program. 

Parent/Guardian #1 Signature *
Please select a signature verification type.
Today's date *
Parent/Guardian #2 Signature *
Please select a signature verification type.
Today's date *