Upward Bound Math and Science SUMMER BRIDGE PROGRAM APPLICATION Application Deadline: Sunday, May 7, 2017 Submission: Via email to ubms@cccc.edu or by mail to:

TRIO Upward Bound Math and Science CCCC 1105 Kelly Drive Sanford, NC 27330

Application Instructions:

1. Thoroughly read the enclosed Handbook PRIOR to beginning this application. 2. Review your proposed summer schedule (enclosed). 3. Complete this form. 4. Attach your essay. 5. Submit all of the following documents to UBMS by the application deadline.

All ACT and SAT score reports CCCC Placement Test Scores, if ACT/SAT scores do not meet course

requirements outlined in Handbook College application submission confirmations Proof of submission of CCCC admissions application All College Admissions Decision Letters (Acceptance, Waitlist, Denial) Scholarship Application submission confirmations FAFSA submission confirmation Student Aid Report (SAR) Financial Aid Award Letters from Colleges Proof of Confirmation of College Enrollment

1. Have you thoroughly read and reviewed the enclosed Handbook?

YES, Initial Here _______ NO (If not, please do so BEFORE proceeding) 2. Are there any changes that need to be made to your summer schedule? For example, one class rather than two, different course selection, etc. (Please see enclosed proposed summer schedule.) YES NO

If yes, please indicate the changes you would like to make and explain why.

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3. Please describe how you plan to travel to and from the Bridge program, or indicate if you will need transportation to be provided for you.

________________________________________________________________ ________________________________________________________________ 4. ESSAY: In 500 words or less, please describe why you are interested in taking a course at Central Carolina Community College and how it will benefit your educational plans. Please type your response and attach it to this application. Please read and initial the following statements: 5. If selected to participate in the UBMS Summer Bridge program, I will attend ALL classes, tutoring sessions, and college seminars, unless I have discussed any expected absences IN ADVANCE with a UBMS staff member. I will not arrive late to or leave early from any class, tutoring session, or college seminar. I will also communicate any expected absences directly with my Course Instructor. Initial Here _______ Please list any expected absences and reasons below: 6. I will FULLY complete and submit on time ALL classwork and homework assignments given by any Course Instructor, Supplemental Instructor, or Summer Bridge Coordinator. I will not turn in any assignments incomplete or late. If I have difficulty with an assignment, I will communicate my concerns with the instructor PRIOR to the assignment’s due date. Initial Here _______ 7. I will respect all UBMS and CCCC instructors, staff, and students at all times. Initial Here _______ Violating any part of this agreement may result in your dismissal from the Summer Bridge program. If you are dismissed, UBMS will discontinue its sponsorship of your course enrollment and you will have to pay the tuition and fees for the course for the remainder of the semester, or withdraw. Please sign below to indicate that you have read and understand the statements above. Student Signature ______________________________________ Date___________

Parent/Guardian Signature _______________________________ Date___________

Questions? Please call (919) 718-7463 or email ubms@cccc.edu.