Thank you for your interest in the Upward Bound program at Los Angeles Valley College. Upward Bound is a federally funded TRIO program sponsored by Los Angeles Valley College and funded by the U.S. Department of Education. The program helps participants with academic success in high school and prepares students to enroll in a post-secondary institution of their choice.

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

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

Once you start the application process you cannot save your work.

Section A: Student Information

First Name *

Last Name *

Middle Name

Date of Birth *

Student Legal Status

Gender *

Street Address *

Apt #

City *

State *

Zip Code *

Student Cell Phone *

Student Email Address *

Do you have a disability? *

If yes, please provide further details:

Student lives with: *

Are you a ward of the court? *

Have you ever been a participant of: *

If so, where and when?

Ethnicity: (This information will be used for reporting purposes only) *

If Other/Multiracial, please specify:

Section B: Academics & Interest

High School Currently Attending or Will Attend: *

What is your current grade level? *

What is your GPA? *

List activities outside of school in which you participate: *

Do you have an after school job? *

If yes, how many hours do you work per week?

Do you plan to attend college? *

After you graduate from high school, what type of school do you plan to attend? *

If Other, please specify:

Are you interested in a STEM related field? (Science, Technology, Engineering, Math) *

What career/s interest you: *

What are your current grades in all your classes? (Ex: Algebra 1 - B, English - A, PE - A, Biology - A) *

Section C: Parent/Guardian Information

Mother/Guardian Name and Last Name

Mother/Guardian Cell Number

Mother/Guardian Email Address

Mother/Guardian's Occupation/Job Title

What was the highest level of your Mother/Guardian's education in the United States? *

Father/Guardian Name and Last Name

Father/Guardian Cell Number

Father/Guardian Email Address

Father/Guardian's Occupation/Job Title

What was the highest level of your father/guardian's education in the United States? *

What is the primary language spoken at home? *

Section D: Financial Aid Information

Note to parents/guardians: The U.S. Department of Education requires that the following information be provided for all participants prior to admission into the program. Answer all questions as thoroughly as you can.

All information submitted is kept confidential. A copy of your most recent tax forms will be requested if accepted into the program.

How many people are in your household? *

What is your family income range? *

If you did not file an income tax return for the most recent year, please indicate your source(s) * *

Section E: Signatures

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. STUDENT - I understand that this ELECTRONIC SIGNATURE is a legal representation of my signature. *

Please select a signature verification type.

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.