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Federal TRIO Programs

UPWARD BOUND MATH/SCIENCE SOUTHEASTERN REGIONAL APPLICATION

Sponsored by the U.S. Department Education

 2021 - 2022

Student Information

Student's Name*
Address*

Date of Birth*
Sex*
US Citizen*
Ethnic Orgin*
Current Grade Level*
Who do you live with?*
Are you currently participating in any other programs, such as Talent Search, Gear Up, etc. *

Student Profile

Please answer the following questions, using your keyboard, to type in the spaces provided below.

Parental Information

Marital Status (please check one):
Mother/Guardian*

Father/Guardian*

Is the parent the student lives with a graduate of a 4-year college or university?*
Does the applicant participate in free/reduced lunch?*
Household Information: Public Housing?*
Indicate untaxed income or benefits received:

Income Verification

In order to officially admit a student to a TRIO Program at Morehouse College, parent(s) or legal guardian(s) must submit income verification.  Please submit ONE of the following income verification documents OR answer the Income Verification Statement below. 

  • a signed income statement from the student's parent or legal guardian
  • a copy of the current 1040, 1040A, or 1040EZ income tax forms (W-2 not acceptable)
  • a copy of your benefits letter from the Department of Family and Children Services, unemployment benefits, Social Security benefits, or Veterans benefits
  • a copy of Free Application for Federal Student Aid (FAFSA) Student Aid Report
Please upload your income verification here. Select choose file to continue.
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2021 Federal Annual Low Income Levels Chart 

Size of FamilyTaxable Income
1$19,320
2$26,130
3$32,940
4$39,750
5$46,560
6$53,370
7$60,180
8$66,990




Income Verification Statement

Please:

(1) Review the 2020 Federal Annual Low Income Levels Chart above. 

(2) Check the appropriate box below.

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Recommendations

Please submit your counselor's and teacher's e-mail addresses for your recommendations. An e-mail will be sent to them to complete your recommendation online.

Counselor's Name*

Teacher's Name*

Signature Authorization

Name*
D.O.B.*

PRIVACY ACT

I understand that the information concerning me, my spouse, and child as a client will be kept in confidence and will not be revealed to anyone except TRIO Programs personnel in accordance with the Family Educational Rights and Privacy Acts.

I certify that all information provided in this application is accurate. I understand that falsifying information will result in immediate rejection of this application.

I authorize Morehouse College Federal TRIO Programs to obtain copies of my child's transcript, test scores, and IEP’s. I permit the TRIO Program staff to release confidential information to postsecondary institutions for educational planning purposes. I also permit the Morehouse College Upward Bound Math/Science Southeastern Regional to pertain information to my post-secondary matriculation. I authorize Morehouse College Federal TRIO Programs to obtain copies of my child's transcript, test scores, and IEP’s. I permit the TRIO Program staff to release confidential information to postsecondary institutions for educational planning purposes. I also permit the Morehouse College Upward Bound Math/Science Southeastern Regional to pertain information to my post-secondary matriculation. I authorize use or disclosure of protected health information, including, but not limited to complete health records during the duration of the grant cycle and shall be in force and effect. This medical information may be used by the program personnel to receive this information for medical treatment or consultation.*
I certify that all information provided in this application is accurate. I understand that falsifying information will result in immediate rejection of this application.*
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