MSU TRiO LOGO
GENERAL INFORMATON:
First Name: *
Middle Name:
Last Name: *
Date of Birth: *
Gender: *
Student's Permanent Address:
City:
State:
Permanent Zip

ETHNICITY:
Black or African American
White or Anglo American
Hispanic or Latino American
Asian American
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
CONTACT INFORMATION
Are you a U.S. Citizen?
Your Cell Phone Number:
Student Home Phone Number:
Student Email:

PARENT INFORMATION:

Please provide the following information about your parent(s)/guardian(s).  (Note:  A guardian is some one other than a parent whom you live with.  A parent is a mother or father.)
Do you live with a parent(s) or guardian(s)?
Name of Parent/Guardian whom you live with:
Parent/guardian cell phone:
Parent/guardian email address:
HIGH SCHOOL INFORMATION:
Name of high school you attend
What is your DPS ID number?
Current grade in high school
Grade you will be in next year
What is your current GPA?
Can you provide a copy of your most current transcript?
What year do you expect to graduate from High School?
What are your BEST subjects in school?
English
Math
Science
Social Studies
Other
What are your MOST DIFFICULT subjects in school?
English
Math
Science
Social Studies
Other
Have you taken any AP, dual or concurrent classes or college courses?
List any pre-collegiate and/or college access programs you participate in:
What is your school counselor's name? (Type "don't know" if you do not know)
What is your school counselor's phone number? (Leave blank if you do not know)
What is your school counselor's email address? (Type "don't know" if you do not know)
POST SECONDARY INFORMATION
What type of college/university would you like to attend?
SCHOOL INVOLVEMENT/EXTRACURRICULAR ACTIVITIES
What sports do you participate in, if any?
What activities or clubs do you participate in besides sports, if any? (If none, type "none")
Are you presently employed?

PROGRAMMING AVAILABILITY

Our Fall/Spring program is from September 18, 2023 to May 24, 2024, and takes place in person at MSU Denver on the Auraria Campus at 900 Auraria Parkway, Room 129, Denver, CO 80217 in the Tivoli building - Monday through Thursday from 4:00pm - 6:30pm with occasional Friday or Saturday field trips and/or activities. Please answer the following questions regarding your availability and participation.
Can you participate in the TRiO program at least two days a week?
Please check two days of the week you are able to attend TRiO during the school week.
Monday
Tuesday
Wednesday
Thursday
Parent(s) or guardian(s) home phone number: (type "don't know" if you are unsure)

TRiO has monthly activities that support college readiness, cultural enhancement and engaging activities.  Are you available at least once a month to participate in a Friday or Saturday activity?
I am not able to attend two days a week (Please explain):

PARENT INFORMATION - The following section must be completed by a parent or a guardian.
Parent(s) or guardian(s) name:
Parent(s) or guardian(s) address where you live:
Resident Agent Name:
Parent(s) or guardian(s) mailing address:
Parent(s) or guardian(s) cell phone number: (type "don't know" if you are unsure)
Parent(s) or guardian(s) work phone number: (type "don't know" if you are unsure)
Parent(s) or guardian(s) email address: type "don't know" if you are unsure)

FOSTER CARE PARENTS ONLY - Do not complete this section if you ARE NOT a foster Parent

If the student is a ward of the court, or in a foster home, please provide the following information.  If they ARE NOT please skip this section and complete the ADDITIONAL PARENT INFORMATION BELOW.
Case Worker Name:
Resident Agent Phone Number:
Case Worker Phone Number:

FAMILY INFORMATION - The following section must be completed by a parent or a guardian.

Student's ability to participate in the TRiO Upward Bound program is partially based on the parent(s) income and education. Please provide the following information for the parent(s) with whom the student lives ONLY.  Select, "Does not live with this parent", if applicable.
With whom does the student live?
Name of "Other" Parent with whom the student lives, if applicable.
Father's Education
Mother's Education
How many people in your household?
Parent Income Range
Sign And Submit

Please submit your most current 1040 income tax form below OR if you did not file a Federal Income Tax Return form the current year complete the NON-FILER'S STATEMENT
Parents most recent 1040 (Upload a copy here):
Applicant/Student Signature:
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Non-Filers Statement

Sign and Submit
Parent Signature:
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Does your child participate in the reduced lunch program at their school?