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Students applying for the LAVC TRiO Upward Bound Program must meet the following criteria:

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1. Must be a U.S. Citizen or Permanent Resident
2. Must be First Generation (Neither parent has a BA/BS or 4yr. College degree) and/or
3. Family’s Taxable Income must meet Federal TRiO Low-Income levels
4. Attend Grant High School, Van Nuys High School, or Robert Fulton College Prep High School

Section A: Student Section


 

First Name *
Last Name *
Middle Name
Address *
City *
Zip *
Email *
Cell Phone Number *
What is your current grade level? *
High School Currently Attending or Will Attend *
Where were you born? Example: Los Angeles, CA *
Birthday (Day of Birth) *
U.S. Citizenship *
Social Security Number (We are a federally funded program and are required to collect this information) Please email Katie for any concerns: delatok@lavc.edu *
Ethnicity *
What languages are spoken at home?
Are you planning to attend college? *
Are you interested in a STEM related field? (Science, Technology, Engineering, Math) *
What major would you like to study in college or what career/job would you like to do in the future? *
How did you hear about Upward Bound? *
What are your current grades in all your classes? (Ex: Algebra 1 - B, English - A, PE - A, Biology - C, Calligraphy - A, Health - B.) *
Do you understand that the LAVC TRiO Upward Bound program is a commitment from the time you are admitted all the way until you graduate from high school? *
Do agree to attend MANDATORY tutoring at LAVC after school if you have D's or F's in your classes? *
Do you agree to attend our 6-week summer classes at LAVC? (Online during Covid) *
Will you maintain a GPA of 2.5 and above all throughout high school? *
Will you attend MANDATORY Saturday Academy classes upon invitation? (On Saturdays, we have SAT Prep, College app assistance, Financial Aid app assistance, personal statements, and non-credited enrichment classes) *
Will you attend workshops upon invitation? (A-G workshops, Junior Timeline, FAFSA, Career Exploration, Senior Night, Study skills, summer and fall orientation) *
Will you go to college and graduate from college? *
On a scale from 1 to 5, 5 being the highest, how sure are you that you want to be a participant of the LAVC TRiO Upward Bound program? *
STUDENT - I certify that my responses on this form are accurate and complete to the best of my knowledge and that any misrepresentation may be cause for denial or cancellation of admission. I understand that I may be requested to provide income documentation. STUDENT - I understand that this ELECTRONIC SIGNATURE is a legal representation of my signature. *
Please select a signature verification type.

Section B: Parent Section


Father/Guardian Name and Last Name
Father/Guardian Cell Number
Father/Guardian's Occupation/Job Title
What was the highest level of your father/guardian's education in the United States? *
Mother/Guardian Name and Last Name
Mother/Guardian Cell Number
Mother/Guardian's Occupation/Job Title
What was the highest level of your mother/guardian's education in the United States? *
Section C: Household Income
What is your family income range? *
How many people are in your household? *
If you did not file an income tax return for the most recent year, please indicate your source(s) *
Upload the first 3 pages of most recent taxes OR other proof of income (disability, Social Security, Veteran's Benefits, Unemployment, Federal/State Assistance, or Other) We are a federally funded program and are required to collect this information for verification purposes. Contact Katie for any concerns: delatok@lavc.edu
PARENT/GUARDIAN - I certify that my responses on this form are accurate and complete to the best of my knowledge and that any misrepresentation may be cause for denial or cancellation of admission. I understand that I may be requested to provide income documentation if my son/daughter is admitted into Upward Bound. I understand that this ELECTRONIC SIGNATURE is a legal representation of my signature. *
Please select a signature verification type.
Parent/Guardian Email *

Section D: Release Authorization


PARENT/GUARDIAN - I authorize the Upward Bound Program access to the following: School Records Release Authorization My child’s school has my permission to release grades, records and test scores to the Upward Bound Program at Los Angeles Valley College. Release Authorization My child has my permission to participate in all Los Angeles Valley College Upward Bound sponsored college trips, six-week summer program, activities and workshops that are planned and supervised by the Upward Bound Program at Los Angeles Valley College. I release the LAVC Upward Bound Program, Los Angeles Valley College, and its employees and the Los Angeles Community College District and its employees, from claims against them arising from injuries, which might occur en route to/at/from the destination. Information/Photography/Internet Release Authorization I give permission to the Upward Bound Program at Los Angeles Valley College to use, release and publish information about or photographs of my child. I trust that the information and/or photographs will only be released when it is in the best interest of my child, or the Upward Bound Program in general, or when the recipient has a legal “need to know” as prescribed in the FERPA and the U.S. Department of Education regulations. PARENT/GUARDIAN - I understand that this ELECTRONIC SIGNATURE is a legal representation of my signature. 

Parent/Guardian Signature for Release Authorization *
Please select a signature verification type.
Today's Date *