Pace Upward Bound Application

Thank you for your interest in the Pace University Upward Bound Program. This program is designed for students who are serious about their academic development and who would like assistance in preparing for college, and the college admissions process. If you meet the following requirements we encourage you to apply: 1. Available on Saturdays during the school year and weekdays during the summer; 2. Will be in 9th, 10th, 11th, or 12th grade during the 2024-2025 school year; 3. A US citizen or permanent resident; 4. Live in Brooklyn OR attend one of our target schools: Academy for Health Careers, Brooklyn Academy of Science and the Environment, Brooklyn Preparatory Academy, Brooklyn School for Social Justice,Clara Barton High School, East Williamsburg Scholars Academy, George Westinghouse High School, or John Jay Law High School.

Please complete this 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 collect the required documents, and then return to submit your application.

We encourage applicants to apply as soon as possible. Applications will be read on a rolling basis, and students will be accepted for the 2024-2025 school year Saturday program or the 2025 Summer program, depending on when their application is received. The program has a limited number of openings, and not every student who applies will be offered admissions into the program.

If you have any questions please email the Program Director, Jennifer Efferen at jefferen@pace.edu.

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APPLICANT GENERAL INFORMATION:

First Name *

Middle Name *

Last Name *

Address Line 1 *

Apartment Number (please put N/A for no apartment) *

City *

State *

Zip Code *

Cell Phone Number *

Email *

Date of Birth *

Citizenship Status *

Ethnicity/Race *

If you answered "Other" or "More Than One Race" on the previous question, please elaborate.

Current High School *

Grade Level for the 2024-2025 School Year *

Anticipated Year of High School Graduation *

What was your score on your 8th grade ELA assessment? If you are in 11th grade, please enter N/A *

What was your score on your 8th grade math assessment? If you are in 11th grade, please enter N/A. *

What was your final grade point average for 8th grade? If you are in 11th grade, please enter N/A *

What was the highest level of math you have completed by the end of 9th grade? *

What is your current GPA based on your most recent transcript? If you are in 9th grade please use your 8th grade final grade. *

Please list any extracurricular activities you are participating in, or plan on participating in.

Are you participating in any other TRIO or college prep programs? If yes, which ones?

Are you related to an Upward Bound student or graduate?

FAMILY INFORMATION

If you do not live with both parents, and do not have the information for the parent you do not live with, please use NA or zeros for the applicable fields.

How many people live in the home, including yourself? *

Are you currently in foster care? *

Please list all people living in the home (parents/guardian, siblings, grandparents, etc.).. Please include their first and last name, age, and relationship to you. *

Mother/Guardian Name *

Mother/Guardian Email Address *

Mother/Guardian Phone Number *

Mother/Guardian Current Occupation. *

Father/Guardian Name. *

Father/Guardian Email Address. *

Father/Guardian Phone Number. *

Father/Guardian Current Occupation

What is the primary language spoken at home? *

What is the highest level of education of the parent/guardian who you live with? If you live with both parents, please base your answer on the parent with the highest level of education. *

If your parent/guardian completed college, what college(s) did they graduate from?

What is your family's taxable income? This can be found on line 15 of your parents' 1040 tax return. This is NOT the adjusted gross income or salary figure. If your parents live together, but file taxes separately, combine the taxable income from both taxes. Please be sure to use the most recent 1040 tax return when completing this question. If your parents did not file, please indicate that and we will ask for other income info if you are invited for an interview. *

(Optional) Please upload a statement telling us a little about yourself, and why you want to join Upward Bound. Please take your time when answering, as we look closely at the personal statement when determine fit for the program. You can submit a written statement, an audio file, a video, poetry, artwork, etc. Whatever you think tells us about you in the format you are most comfortable.

Please upload a copy of your high school transcript. This must include your overall GPA. If you are in 9th grade, and do not yet have a transcript, please upload your most recent report card. If you are submitting your application before the first marking period, please upload a note stating such. Please include in the note what you think your overall average might be. If you are in 10th, 11th, or 12th grade you MUST submit a transcript. *

Please upload a copy of your valid US passport, or US birth certificate, or Permanent Resident Card *

How did you hear about Upward Bound? *

Terms: By submitting this application we agree that the all the information in this application is true, including financial/income information and educational levels of parents/guardians. It will be kept confidential, and is being given for the receipt of federal funds, and the United States Department of Education may verify it. We certify that the information contained in this application is complete and accurate to the best of our knowledge. We also understand that any misrepresentation may be cause for denial of admission, or dismissal from the program once accepted.

Please be advised that filling out an application does not guarantee you an interview, and an interview does not guarantee admission. Upon completion of this application, the program may request additional supporting materials including copies of tax forms, transcripts, birth certificates/permanent resident cards, and school/teacher recommendation forms.

As the parent/guardian of this applicant, I give my permission for them to fully participate in the Pace University Upward Bound Program. Full participation in this case includes the following: all tutoring, counseling, home visits and/or any other outreach efforts, trips, exercises, small discussions, academic and enrichment workshops, all related testing to monitor student progress and evaluate effectiveness, and any and all other allied activities that occur under the auspices of this program. This includes in-person, and virtual activities. In consideration for my child’s participation, I hereby release Pace University, its officers, employees, volunteers, interns, and students and his/her respective high school (named below), from claim, legal actions, and damages which might result from his/her participation in the program including related transportation. I authorize the Pace University Upward Bound Program to obtain copies of, and/or review school records, and understand that records will be used in planning appropriate support services for my son/daughter as well as record keeping and completion of any and all required federal reports. I acknowledge that all Upward Bound staff/interns/volunteers have a duty to protect the safety and well being of any Upward Bound student. I (we) understand that all information will be kept confidential.

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Parent/Guardian of applicant - Please provide your signature *